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HomeMy WebLinkAbout2500 EL CAMINO REAL; ; SE1971; PermitCITY OF CARLSBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION FOR APPLICANT TO FILL IN LEGAL. DESCRIPTION LOT NO P/^-JLC-iS-t- fc^ I PS- (2£, BLOCK P&fe£j5.L, M&P&- ^€>f USE' OF «._, / BUILDINGS -=^ >£ £Lj7/£ £ ZSf&flDltj CONTRACTOR /-^ ' rf-^ ' f^3 ^&7&& ^ CJ&^p ADDRESS , CITY TEL NO CONTRACTOR S STATE CARLSBAD BUSINESS LICENSE NO LICENSE NO NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 OO SEPTIC TANK SEEPAGE PIT OR PITS @ $5 00 OVERFLOW SEEPAGE PIT DRA1NFIELD EXTN CESSPOOL DRYWELL MANHOLE @ S5 OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 5O CONNECT ADDITIONAL BLDG OR ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ S2 OO @ $ OWMPP'Q PERMIT S 2 OO AUTHORIZATION TOTAL FEE 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 ADDRESS . — — 1 HEREBY ACKNOWLEDGE THAT 1 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 1 HEREBY CERTIFY THAT 1 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 BUILDING / f r /-ADDRESS r7frfM.fri2- ^ &L. Cd-Mib. NEAREST CROSS ST ]Q?k(^ OWNER <^T"ft(00 /ri2-v} Of L~ SSiLi/ ^J"*~A 1 MAIL -i ^_ . ADDRESS 14.7^ 65- S7~ J. T5._ *? '* CITY TEL NO CONNECTION DATA Lateral Charge Computat.on ByCouj-p^ 30' H . 10' V © 4" — _ '/>" — Add Horjz £cD 4" — A" — Add Vert © 4" — _. h" — Total Construction Cost 10% Service Charge Total Lateral Charge Lat No . Logged in Plat I f£> ( -o£- ^S y ( ) ( LINE COST DATA A D & Assmt No — i INF COST I>e?05rr M&r- ^.T-^LS-ZZ. c c ©52?— / d££J#g~_ -4 i/w'rs ^QO°~ P S @ / Hu/nllmg OTHFR s=? m Grand Total, Lateral, etc FOR SEWER LOCATION CO St ENGINEERING _ - SEWER DEP S.gned frV^ fU^. Signed -i-to NORTH r This is a Sewer Permit When Properly Filled Out, Signed and Validated Issued By PERMIT VALIDATION