HomeMy WebLinkAbout2271 CAMEO RD; ; SE658036; PermitCITY Of CARLSBAD
BUILDING DEPARTMENT
803*.SEWER
PERMIT - APPLICATION
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION
.;; ADDRESS
CITY NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESSLICENSE NO.
NO.
)
—
DESCRIPTION OF WORK FEE
HOUSK SEWER CONNECTING TO
PUBLIC SEWER @
SEPTIC TANK. SEEPAGE PIT OR
PITS @
$3.00
$8.00
OVERFLOW SEEPAGE PIT, DHAINFIELD EXTN..
CESSPOOL, DRYWELl.. MANHOLE @ $5.OO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER &
SI. 50
ST. so
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.OO
& S
OWNER'S PERMIT S
AUTHORIZATION TOTAL FEE
J
2
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1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD-
ING TO THE PUBLIC SEWER.
SIGNED THIS —_
OWNER OR
OWNER'S AGENT
DAY OF
ADDRESS
i HEREBY ACKNOWLEDGE THAT i HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS.i HEREBY CERTIFY THAT i AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-
BAD AND STATE OF CALIFORNIA OR THAT I AM THE. LEGAL
OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP-
ERTY.
SIGNATURE \
OF PERMITTEE^
37-65 !PAID
CITY
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V.
Add. Horiz.
Add. Vert.
10% Service Charge
_at. No.:
Total Construction Cost
Total Lateral Charge
Logged in Plat:
LINE COST DATA
A. D. & Assmt. No. . .
LINE COST:
C. C. @__ / dwelling - ,
P. S. @ / dwelling
OTHER
TOTAL
Grand Toral, Lateral, etc.
FOR SEWER LOCATION
St.NORTH
ENGINEERING SEWER DEPT.
Signed Signed __
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By _ ,
PERMIT VALIDATION