HomeMy WebLinkAbout2409 BURGOS CT; ; 77-8514; PermitBUILDING PERMIT APPLICATION
8 Class of work: w' 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE
ity of CARLSBAD, CALIFORNIA 92008
(OSEE ATTACHED SHEET1
CONTRACTOR MAIL AOORESS PHONE STATE LIC. NO. CITY LIC. NO.
*i$3P?RY 3 ~ "C I 4 8 i'i" .&*
ARCHITECT OR DESIGNER MAIL AODRESS PHON E LICENSE NO
. ,? Ld
LICENSE NO. ENGINEER MAIL AODRESS PHONE
Change of use to
b 11 Valuation of work: $
SPECIAL CONDITIONS:
*f
,JC ,p
APPLICATION ACCEPTED BY PLANS CHECKED BY
DATE I
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
ING, HEATING, VENTILATING OR AIR CONDITIONING.
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS,OR IF
CONSTRUCTION OR WORK ISSUSPENDED OR ABANDONED FOR A
MENCED.
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN0 KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL-BE COMPLlEO-WITHWHETHER SPEElFlED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV'E AGTHORITY TO VIOLATE- OR CATY-E THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE Or CONTRACTOR OR AUTIIORILED AGENT (DATE)
SICNATURE OF OWNER (IF OWNER DUILDERI (DATE)
PLAN CHECK FEE S /dd 251 PERMIT FEE S
Size of Bldg. No. of Mar.
(Total) Sq. FZ 194 Stories 2 OCC. Load -
Fire Sprinklers
Required myes [3F( I - OFFSTREET PARKING SPACES:
L No. of
Dwelling Units 2 !:bered 4 I Sq. Ft.
Special Approvals I Required 1 Received I Not Required
PLANNING DEPT. i I I
HEALTH DEPT.
FIRE CIEPT. I 1 I
I 1 ~~
SOIL REPORT
OTHER (Specify)
ENGlNEERiNG DEPT. I I I
WATER DEPT. I I I
I 1 I
WHEN PROPERLY VALIDATED (IN THIS SPACEJ THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
d22 a-
TOTAL FEES $
INSPECTOR
_-_ i ___ _"
r
' ELECTRICAL PERMIT APPLICATI
City of CARLSBAD, CAUFWIA 92008
Phone 7294181 lpplicant to complete numbered spaces Only.
JOB ADDRESS
LOT NO. BLK. TRACT LEGAL (OSEE ATTACHED SHEET) OESCR.
OWNER ' MAIL ADDRESS ZIP PHONE
438-1633
l Class of work: mEW ADDITION 0 ALTERATION 0 REPAIR
PECIAL CONMTI,NS:
P
ICILICATION ACCEPTED BY PLA~ECKED BY APPROVED FOR ISSUANCE BV
DATE
NOTICE
TlON AUTHORIZED IS NOT COMMENCED WITHIN 120 OAYS.6R IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM MENCED.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRW-
' .7
>lGNA=ME 0 F OWNER (IF OWNER BUILDER) {DATE)
WHEN PROPERLY VALIDATED (IN tr-
PLAN CHECK VALIDATION CK. M.O. CASH
NEW CONSTRUCTION, FOR EACH AMPERES OF MAIN SERVICE, SWITCH, FUSE OR BREAKER 100
NEW SERVICE ON EXISTING BLDG. FOR EA. AMPERE OF INCREASE IN MAIN SERVICE, SWITCH, FUSE OR BREAKER 4
REMODEL, ALTERA~ION, NO CHANGE IN SERVICE, FOR EA. AMPERE OF
INCREASE
Ill5
TEMP. SERVICE UP TO AND INCLUD- ING 200 AMP.
TEMP. SERVICE OVER 200
I I
HIS SPA&) THIS IS YOUR PERMIT
PERM IT VAL I DATION m. M.O. CASH
..
..
INSPECTOR
MECHANICAL PERMIT APPLICATION 5-'' -' ge$p*ul. *
7-10 City of CARLSBAD, CALIFORNIA 92008"" -E '*
Applicant to complete numbered spaces only. Phone 729-1 181 Perm it No.
JOB ADDR ESS
DLX TRACT
2409 BU~QS Ct*
LOT NO. LEGAL (OSEE ATTACHE0 SHEET) DEacI.
owncn . MAIL ADDRESS ZIP PHONE
I Manhattan L.C. Enterprises-73174 Alicsdrt Rd., La Cos%a, GA 82008 438-16
' CITY LIC. NO. STATE LIC. NO. CON TRACTOR MAIL ADDRESS PHONE
Eswndido Heating 6 Air C%W3., fnc,-t665 Ezietcalf St., J3Scondl;&ar CA 92025
ARCHITECT OR DESIGNER MAIL ADDRESS PHON F LICENSE NO.
LICENSE NO. ENOlNLLl MAIL ADDRESS PHONE
LLNDLI HAIL ADDRESS DRANCH
"% 6-
USE 01 BUILDING
Sinqle Family midem
Class of work: mEW 0 ADDITION ALTERATION 0 REPAIR
Heating Describe work:
r
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS.OR IF
CONSTRUCTION OR WORK ISSUSPENDED OR ABANDONED FOR A
MENCED.
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
t HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV'E AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
WEN PROTERLY VALIDATED IIN lHlS,~ACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
.,
. b, .. . .. ... ..
IN3PtL I UK
PLUMBING PERMIT APPLICATION
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
6
1
MAIL ADDRESS BIANCU
USE OF BUILDING
(8 Class of work: 6 ADDITION ALTERATION 0 REPAIR
19 Describe work:
ISPECIAL CONDITIONS:
APPROVED FOR ISSUANCE BY
Lj DATE
,' :
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PERMIT FEES
Type of Fixture or Item 1 Fee
1 WATER CLOSET fTOlLETI
BATHTUB
LAVATORY (WASH BASIN)
SHOWER c "t
KITCHEN SINK I DlSP
DISHWASHER
LAUNDRY TRAY 23 CLOTHES WASHER
- C, .) WATER HEATER
URINAL
DRINKING FOUNTAIN I
I FLOOR-SINK OR DRAIN II I SLOPSINK ---I 1
~~ .- ~- .ac) GAS SYSTEMS NO. OUTLETS /& [ .;II .*
I WATER PIPING b TREATING EQUIP. I I I .~ I I I WASTE INTERCEPTOR
I VACUUM BREAKERS II I LAWN SPRINKLER SYSTEM II I ,
SEWER NUMBER CLEANOUTS VI *,I * c CESSPOOL I SEPTIC TANK I PIT I ROOF DRAINS
I I
ISSUANCE FEE SI -71 52-
TOTAL FEES SI \-Lk I*
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.
INSPECTOR
REQUEST FOR INSPECTION TIME: A%
DATE: 9-6-78 7
I -&a&l - u
1NSPECTOR
OWNER
ADDRESS 309
o FOUN-
0 REINFORCING STEEL
0 MASONRY
0 GROUT - GUNITE
0 FLOOR AND CEILING FRAME
0 SHEATHING
0 FRAME
0 EXTERIOR LATH
0 INSULATION
0 INTERIORLATH OR DRYWALL
FINAL
/
PLUMBING
0 UNDERGROUND PLUMBING
0 UNDERGROUND WATER
0 ROUGH PLUMBING
0 TOP OUT PLUMBING
0 SEWER AND PL/CO
0 TUB OR SHOWER PAN
0 GAS TEST
0 WATER HEATER
0 FINAL
ELECT R I CA L
0 TEMPORARY SERVICE
0 ELECTRIC UNDERGROUND
0 ROUGH ELECTRIC
0 POOL BONDING
0 ELECTRIC SERVICE
0 CEILING HEAT
U G.F.I.
0 SMOKE DETECTOR
0 FINAL
______~ MISCELLANEOUS
0 PLENUM AND DUCTS
0 COMBUSTION AIR
0 PATIO
0 SIGN
0 GRADING
0 DRIVEWAY
0 CONDITIONED AIR SYSTEMS
0 REFER PIPING
0 FINAL
READY FOR INSPECTION: 0 MONDAY 17 TUESDAY 0 WEDNESDAY 0 THURSDAY &R I DAY
~QA.M. /&m 0 P.M.
SPEC I AL I NSTR UCTl ONS
a
REQUESTED BY 1 PHONE NO.
PERSON TAKING REPORTA
-- CORRECTION LIST CITY OF CARLSBAD
BUILDING DEPARTMENT
SINGLE FAMILY AND MULTIPLE FAMILY RESIDENTIAL PLAN
*WARNING: PLAN CHECK FEES: Where no action is taken by the applicant in 120 days,
and no building permit is issued, all
Job Address: 2S/hS Owner
Contractor: B Engineer
Occupancy Type of Construction Valuation
Basic allowable bldg. area 1st Floor 2nd Floor
3rd Floor 4th Floor -
Allowable Increase Due to
REQUIRED PLANS
1. Plot Plan 6. Structural Details
2. Foundation Plan 7. Elevation Plans
3. Floor Plan 8. Roof Plan
4. General Framing 9. Index Sheet
5. Foundation Details
TO THE APPLICANT
A. Correct Plans where corrections has been circled. Flag
Corrections.
B. Incomplete, Indefinite or Faded Drawings or Calcu-
lations not acceptable.
C. Required Engineer’s or Surveyor’s Calculations or
Plans shall be signed in ink.
24. Indicate clearance from grade to bottom of floor joists
25. Show pier size, spacing and depth, into undisturbed
, soil.
26. Show girder size, spacing and direction.
27. Show all conditions of soils report on plans.
28. Show positive drainage away from footings on site
29. Specify minimum 18” x 24” access opening.
30. Where expansive soils exist, planters adjacent to found-
ations are not recommended.
31. Specify underfloor ventilation equal to 2 square feet
for each 25 lineal feet of foundation plus one opening
within 3’ of each corner.
and girders.
plan. 5” fall in 6 feet.
32. Step footings when slope exceeds 1 : 10.
D. Reverse Plans may not be used. Provide correct Plot
Plan, Foundation Plan, Floor Plan and Elevations.
E. The approval of plans and specifications does not
permit the violation of any section of the Building
FRAMING
rovide typical framing details. R$&P* pecify all lumber grades. p1)/@68P ..
pecify fire blocking at floor, ceiling cove and mid-
eight of walls over 10’ in height.
36. Show diagonal bracing at each corner and every 25
ode’or other City, County or State Law.
feet of wall. GENERAL
fully dimensioned Plot Plan, drawn to scale, 37. Clarify bracing of wall.
are overspanned.
38. Show size, direction and spacing of floor joists in
39. Double floor joists or
40. Specify header size for openings over 4’. Show double
P ng all easements on property. J
ow all existing and proposed buildings on Plot Plan.
Show correct legal description on Plan.
4. Show all Off Site Improvements, Driveway Approach,
Light Standards, Fire Hydrants, Water Meters, Sub
Structures, Trees, etc.
beam under parallel partitions.
headers on edge.
. Correct Lot Dimensions. 41. Insufficient beam size at
42. Provide rafter ties where ceiling joists and rafters are
WeY d=k-sP- ’ .ma 6 v&ae&! not parallel. 4’0.C.
dicate all grading to be done. 43. Indicate rafter size, span, spacing and direction.
44. Show purlins on edge and indicate size. Same size as
45. Brace roof framing to partitions.
46. Indicate solid sheathing and 2 x 6 or 3 x 4 studs on
47. Show section through
48. Show planter box details and water proofing, Sec.
5 1. Provide typical chimney details.
13cL.C.W.D. sewer receipt required. 52. Specify 2” minimum clearance between chimney and
13dCoastal approval letter required. framing.
14. Carry water from 53. Specify post protection when bearing on concrete.
how existing and finish contour lines.
9. Indicate Elevations of Garage Floor, and Street and’
Driveway. rafters minimum. 10. Indicate Centerline and Edge Profile of Driveway.
ope of driveway not to exceed I&.
icate flow lines for disposal of surface water.
Costa approval required.
first floor of three story construction.
Diego County Health Dept. approval required.
Show all requirements for handicapped. U.B.C. 2517 C7.
Section 1711.
under sidewalk through curb into street with cast
iron pipe.
54. Provide parapet details.
56. Specify inspection class
58. Provide drip screed 2” below mud sill.
59. Indicate how required structural and fire resistive
16. Provide engineer’s moisture report. integrity will be maintained. Where penetration will
17. Grading permit required. be made for electrical, mechanical, plumbing and
18. Fire Dept. approval required. communications conduits, pipes and similar systems.
19. Specify concrete mix @ 2000 P.S.I. minimum. Section 301 D.
20. Dimension footing sizes and clearance from grade.
21. Show depth of footings below natural or undisturbed
22. Indicate pressure treated foundation still, or equal.
23. Show foundation bolt size, spacing and penetration
15. Provide engineering calculations for required for
60. Clarify dimensions at
61. Show window type, sizes and locations.
62. Light and/or ventilation inadequate in grade.
(1/10 floor area - 12 square feet min. except bath-
room). into concrete. VZ” x 17” for masonry.
I **NOTE IN MARGIN WHERE CORRECTIONS HAVE BEEN MADE
77- W6
vertical clearance and
dicate attic scuttle (22” x 30” min.) ,A - 2
orizontal clearance from range top to combustibles.
rovide draft separation for attic area in excess of
2500 sq. ft.
66. Separate area between dropped ceiling and floor above
to 1000 sq. ft. max.
67. Specify stall shower min. width 30” minimum floor
area 900 sq. inches.
68. Specify wall finish in shower area not to be adversely
affected by moisture to 6’ above the floor, and provide
shatterproof doors.
69. Water closet area minimum width to be 30”.
70. Show material to be used under tile.
7 1. Openings closer than
72. Show ceiling height.
73. Show lateral cross bracing at garage plate line.
74. Show bedroom window as exit, section 1304.
to property line shall be of hour construction.
110. Indicate material to be used and location of sewer
(If V.C.P. use flexible compression joints only.)
11 1. Show two way clean out in yard box with 5’ of build-
line.
ing.
ELECTRICAL
112. Provide minimum 100 Amp. service. Condos require
113. Show meter and panel location.
11 3aShow fire warnings systems centered over stairs.
100 Amp. panel for each unit.
Section 1310.
MECHANICAL
114. Indicate furnace size, locations & registers and return
115. Indicate heating equipment in accordance with chapter
116. Specify heating, air conditioning and ventilating
air. (Size)
7 of Uniform Housing Code.
equipment. Installations to comply with the uniform
mechanical code.
A. Access F. Ducts
B. Location G. Ladder & Light
ELEVATIONS
te attic ventilation per section 3205 (c).u
all eave overhangs and construction details. 9 b- -’\ 77. Dimension chimney height above roof. (2’0’’ above C. Combustion Air H. Engineer’s
78. Indicate finish and natural grade to property line.
79. Show exterior wall finishes.
80. Indicate 15# felt or equd on exterior walls.
roof withing 10’0’’). D. Venting Calcs for
E. Return Air Roof Loads
117. Indicate location & type of fire dampers.
ELECTRIC
ROOF 1975 N.E.C.
81. Note roof pitch. 1. Ground-fault protection required for outdoor and
82. Indicate roofing material length & weather exposure bathroom receptacles 210-8.
least one receptical shall be installed outdoors
garages. 2 10-25b
on wood shingles.
83. Show type, size and spacing of roof sheathing.
84. Fire retardant roof required due to location in orrect electric as shown on floor plan. /2, ’16 fire zone.
Underground service is required. Show on plans.
MISCELLANEOUS ITEMS
GARAGES
86. Garages not permitted to open into sleeping room.
87. Provide separation on all walls
88. Specify- doorlwindow opening 7 0 2. Provide
and ceilings adjacent to living quarters.
from garagelcarport into
2 f P.3FALf 3 7 00
STAIRWAYS AND EXITS
90. Provide handrails as required in Section 3305 (i).
92. Provide pF&3 7 z r) hour walls for stairwell.
3. Insulation requirements:
A. Show 6” insulation in ceiling. (R-1
B. Show 1 x block for insulation stop
C. Show 4” insulation in walls (R-11)
D. Show exterior doors weatherstriped.
E. Place the following note on plans:
These plans comply with the requirements of the
California noise insulation standards. h& .L
maximum rise and minimum i/ 1 93. Indicate
95. Provide balcony railing at 42” minimum height. 36”
96. Provide intermediate rails @ 9” O.C. or equivalent
97. Indicate 6’ 6” minimum headroom clearance above
98. Show stairway construction details.
y( run on stair.
O.K. for single family units.
for open type balcony & stair rails.
stairway.
100. Occupant load requires exits
from
10 1. Provide lights over stairways and public corridors.
102. Show change in floor level at doors 1” max. Sec.
3303h.
102aShow handrail extending 6” beyond the top & bottom
risers & terminating in a post or safety terminal Sec.
3305 (i).
PLUMBING
103. Indicate location of water heater.
104. Show temperature and pressure relief v
heaters with discharge lines to outside. Skc. 1007.
105. Water heater not to be located in bathroom or under
stairway or landing.
106. Provide square inches of ventilation at top and
bottom of water heater.
107. Show water heater on 18 inch platform.
w details of party wall and floor system a d
C. or I.C.C. rating of each. &
(DATE) /
THE FOREGOING CORRECTIONS HAVE BEEN MADE
AND ARE UNDERSTOOD BY THE UNDERSIGNED:
OWNER - OR HIS AUTHORIZED AGENT
- ' I"'? r)
INTERDEPARTMENTAL INFORMATION SHEET
RECEIVED"
BUILDING DEPARTMENT
BUILDING ADDRESS:
PLANNING DEPARTMENT
ZONE $.,-?J.-. LOT SIZE &> LOT WIDTH
LTNITS ALLOWED + UNITS PROVIDED 3-
PARKING SPACES REQUIRED PROVIDED
% COVERAGE ALLOWED PROVIDED 3
\ PROVIDED bf& h BUILDING HEIGHT ALLOWED
I
FRONT SETBACK:
ALLOWED
SIDE SETBACK: REAR SETBACK:
PROVIDED
INTRUSIONS 1 LANDSCAPE & IRRIGATION PLAN COMMENTS:
I~NVIRONMENTAL PROTECTION REQ : c&pAh~cle
OK TO FINAL
ENGINEERING DEPARTMENT
R.O.W. (--c=wv INDUSTRIAL WASTE ,A IMPROVEMENTS E%F 7'
SEWER CONNECTION c&L> DRIVEWAY LOCATIONS &!?U/'=,@ .m. $*,;+&y b/
GRADING PERMIT &)e EASEMENTS &- DRAINAGE/^ &% Sdc
LEGAL DESCRIPTION^^ 2+, I/. e. si,
ADDITIONAL COMMENTSSee 2 e / QY N-s
FIRE DEPARTMENT
S P P I XKL I NG S Y S TEM FIRE PROTECTION EQUIP.
FIRE ALARXS EXITS
FIRE HYDRANTS LOCATION
ADDITIONAL COMMENTS
- OK TO ISSUE: DATE OK TO FINAL DATE
WATER DEPARTMENT
* REQUIREMENTS OF APPROPRIATE DISTRICTS MET DATE 77-- \
LEUCAUIA COUSTY WATER DISTRICT --- APPLICATION FOR SEWER SERVICE
545-661 5 hncr's Xarnc: Manhattan L.C. Enterprises Phone No.
~~~i1i~~g Addre:;s: 1020 Manhattan Beach Boul ward
Date Paid 3-1-77
,Rec'd by 3. Geiselhart
Manhattan Beach, Ca. 90266
Type of Building: No. Units
Lateral Size: 4" 6" 8" Saddle :
Extra footage: @$ Easement Connection
- -
%
Extra depth: .@$ Lateral Charge
Total $1 7,500 -00
The application must be signed by the owner (or his authorized representative) of the
property to be served.
application is submitted . The total charges must be paid to the District at the time the
If a service lateral is required, it will be installed by the Leucadia County Water
District.
main collection line in the street (or easement) to the point in the street (at or near
the applicant's property line) where the service lateral is connected'to the applicant's
building sewer.
expense, of the sewer pipeline (building sewer) from the applicant's plumbing to the
. . point in the street (or easement) where a connection is made to the service lateral.
The service lateral is that part of the sewer system that extends. frob the
The applicantr is responsible for the construction, at the applicant,s
The connection of the applicant's building sewer to the service lateral shall be made
by the applicant at his expense.
District's specifications, rules and regulations; and IT MUST BE INSPECTED AND APPROVED
BY THE DISTRICT BEFORE THE SEWER SYSTEM MAY BE USED BY THE APPLICANT.
HIS AUTHORIZED REPRESENTATIVE, MUST NOTIFY THE DISTRICT AT THE TI€% INSPECTION IS DESIRED.
The connection must be made in confornity with the
THE APPLICANT, OR
ANY CONNECTION MADE TO THE SERVICE LATERAL OR COLLECTION LINE WITHOUT
INSPECTION BY THE DISTRICT WILL BE CONSIDERED IRVALID AND WILL ROT BE
After connection is complete, the property described above is subject
sewer service charge, billed bi-monthly in advance. The rate will be
use of the property, single family, multiple dwelling or commercial..
PRIOR APPXOVAL AND
ACKXOVLEDSED .
to a monthly
governed by the
Non-payment of
.the sewer service charge is subject to a 5% penalty per month, plus disconnection if
necessary .
The undersigned hereby agrees that the above information given is correct and agrees to
the conditions as stated: ...
61 11 -61 45 .*.
*. Owner's Signature Date Account No-