HomeMy WebLinkAbout2431 BUENA VISTA CIR; ; SE1968; PermitCITY OF CARBAD-
NO.
- BUILDING DEPARTMENT
DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 l3.00
SEPTIC TANK. SEEPAGE PIT OR
PERMIT - APPLICATION
FOR APPLICANT TO FILL IN I
BUILDING ADDRESS 2431 B-4 b\m
NEAREST
LEGAL DESCRIPTION LOT NO
BLOCK TRACT CROSS ST. LAGuuCt p&b USE OF BU lLDl NGS
CONTRACTOR [dbwu $ sy ADDRESS
ADDRESS CITY TEL. NO.
e, 0, 5TXkTOk.l OWNER
MAIL
CITY TEL. NO.
CONTRACTOR'S STATE CARLSSAD BUSINESS LICENSE NO. LICENSE NO.
I PITS I OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. CESSPOOL, DRYWELL. MANHOLE QP $5.00
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.50
CONNECT ADDITIONAL BLDG. OR
ALTER. REPAIR OR ABANDON HOUSE
WORK TO HOUSE SEWER QP $1.50,
SEWER OR DISPOSAL SYSTEM @ $2.00
0s
PERMIT
TOTAL FEE 1 OWNERS
AUTHORIZATION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD. ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF OWNER OR OWNER'S AGENT
I HEREBY ACKNOWLEDGE THAT I HAVE RMD THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
.. SIGNATURE OF PERMITTEE
CONNECTION DATA Lateral Charge Computation
@ 4" = ___ bn
30' H.. 10' V. @ 4" = - 6"
Add. Horiz. @ 4" = ___ 6"
Add. Vert.
Total Construction Cost
10% Service Charge
Total Lateral Charge
Lat. No.: Logged in Plat:
LINE COST WTA
A. 0. & Assmt. No.
P. S. 6- / dwelling
OTHER
Grand Total, Lateral, etc.
FOR SEWER LOCATION
NORTH
SEWER DEPT.
Signed c I Signed
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION