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HomeMy WebLinkAbout251 CHINQUAPIN AVE; ; SE658568; PermitCITY OF CARLSBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION jPAIDSEP 11-65 !Fir16M6******5000 FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO BLOCK TRACT USE OF A * BUILDINGS ~ Xy-JZtA-^ „ ^- CONTRACTOR J5£^^x^^^f.^>«^S&:^t^»^x< 1 ADDRESS m CITY CONTRACTOR S STATE LICENSE NO NO DESCRIPTION OF TEL NO CARLSBAD BUSINESS LICENSE NO WORK FEE HOUSE SEWER CONNECTING TO m . -\ PUBLIC SEWER @ it3 OO £f- f~f' SEPTIC TANK SEEPAGE PIT OR PITS @ $S OO OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $S OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 SO CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 SO ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2 OO OWNER S AUTHORIZATION 1^1 HAVE AT THIS DATE A 1 CONTRACTOR TO CONNEC ING TO THE PUBLIC SEW SIGNFP THIS OWNER OR OWNFR S AGENT ADDRESS - — @ $ PERMIT $ 2 OO TOTAL FEE ,3^ ^~^ CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD ER DAY £F 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 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE-'CPrY OF CARLS BAD AND STATE OF CALIFORNIA OR THiSffTAM THE LEGAL OWNER OF THE ABOVE/&ESCRIBE0-'WESliaBNTIAL PROfP- SIGNATURE ^~^A &> /^A^,\^>K^y^( / J A J9-?/J BUILDING — ^- f A 4 0 ^ NEAREST >^ ^^ftf *N ^7^ "•" CROSS ST -<*X &L/} --ivrfX wPx*?^'*'' ^.j.*.*.* OWNER P^^a^'^d^^/feJfi^i' I,XMAIL . ^ ^' -f'^^:~ ^ADDRESS ^ y* > ^t^X ,»ir'rf -C ^*-<* -^* ^X-— C'TY /* /L^x^J^Z^^^L N0 ^ CONNECTION DATA Lateral Charge Computation 30 H 10 V & 4 — A" — Add Vert @ 4 — A — Total Construction Coit 10 / Service Charge Total 1 ntfirnl Chargn Lat No Logged in Plat LINE COST DATA A D & Assmt No LINE COST C C & ^ / Hwfillmg -^~^ — PS© / HwBllmrj OTHFR TOTAI FOR SEWER LOCATION 1/5 W St NORTH ENGINEERING SEWER DEPT Signed .. ^iqnnH 600 This k a/Sewer Permit When Properly Fijled Out Signed and Validated Issued By PERMIT VALIDATION