HomeMy WebLinkAbout2584 LUCIERNAGA ST; ; 77-2820; PermitMO()EL NO.c:..-•-------~--BtJ . B ING PERMIT APPLICATION .-v
' . · dS"J{.-1):;,, C.ity of CARLSBAD, CALIFORNIA 92008 1L
Applicant to complerfn'Yl:t ed spacts only. Phone 729-1181
_...,, -Permit No.
JOS AOOR CSS /-ASSESSOR'S
.,. ~-·(_JG, I ~ °S T ~£.. .... 13> [.) (/J~,: PARCEL NUMBER -. ·-
LOT NO I I LK I, r••cT
BvvK PAGE I PAR.
LtcAL I --/2 7 /. l-'l/1 -'!:~ u--,..v .. -:J (fSEl ATTACM£0 5"[ <Tl 1 OtSCA. ,,.. (.. ... ~ ,
OW NCR MAIL AODRC55 ?Ip PHONE , '-2 .---r,Jr:,. ..;'I~.":'.: .... "'.
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CONTRACTOR MAIL ADDRESS PHONE or.... STATE LIC. NO. CITY LIC. NO.
3;:---~ --I.J~::.f?'f'?.; . ·'-\i'j,; tt J; ,.
·-A RCHIT(CT OR OCSIGNCR MAIL AOORE:55 PHONE LIC CNSC NO,
4 .
"''~-"'t" tlu:. tb<!.-.._.. . , u-. c __ ..--_.f,/2---.__..._"'' -...
tNGl"ICCF\ MAIL A0ORC55 PHONE LICC,..SC NO.
5 ! -.
COMPENSATION INS. CARRIER MAIL AOOIH.SS BRAN CH I .
6 .o.\ -( t Or::1_ l2t .J ~ _r . .... , .. t . '
use OF BUILDING -
BATHS /) 7 -_ _.........-NO. BORMS NO.
8 Class of work: 9 NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE fl ~r
9 Describe work: fJP 1/ ( V
'7 91~ -/J'I '·
10 Change of use from F VJ"
Change of use to
11 Valuation of work: $ <:,o _..,ic'lO eO I (.J , I I/ -PLAN CHECK FEE $ PERMIT FEE $
SPECIAL CONDITIONS: -r[rJ MICRO FILM FEE
Type of Occupancy I Const Group I -
Sile of Bldg. 317(.. No. of J Max.
(Total) Sq. Ft. Stories 0cc. Load
Fire ~ use £/~ Fire Sprinklers
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR 1$$UANCE BY Zone zone Required 0 Yes 0No , OFFSTREET PARKING SPACES
DAT~
N o_ of d--Sq. Ft. 9SO 1 ~~en DATE Dwelling Units No.
Covered j
NOTICE Special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB· PLANNING DEPT.
ING, HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF F IRE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ENGINEERING DEPT
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS WATER DEPT.
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT OOES 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.
SIGNATURC 0,. CONTRACTOfl OR AUTH011111CD AGCNT IDATC)
~ -<1q(iNA,TIIJII[ 0,. OWN£ .. ,,. OWNCJII IUll.DEIIII OATt) . WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
_) I 2)· T OT AL FEES $ ----''---=---c:......---
INSPECTOR
TIME·-------R~~U~ST ~~ ~NSPECTION
INSPECTOR ~ PERMIT NO ________ DATE: ( 9:-C-7P'
OWNER _____________ -:,;--------------------
ADDRESS __ ,;)='.:_~-::!._· ~_J:IK"l.__HC//(_'.tL.J., P1./;.,._______..a,,:;,~•"'i:t:;-d~Ji::::,-e::;. 2:::b~-~--~-i:..--------, / ,,.
BUILDING
0 FOUNDATION
0 REINFORCING STEEL
0 MASONRY ! 0 GROUT -GUNITE ,
0 FLOOR AND CEILING F. fME ,
0 SHEATHING ' /
0 FRAME ( 1 ' · 1 i). / </ 0 EXTERIOR LATH
0 INSULATION
\ l+J INTERIOR LATH OR DRYWALL '
'-tJ FINAL
I "
PLUMBING
0 UNDERGROUND PLUMBING
0 UNDERGROUND WATER
0 ROUGH PLUMBING
0 TOP OUT PLUMBING
0 SEWER AND PL/CO
0 TUB OR SHOWER PAN
D GAS TEST
D WATER HEATER
D FINAL
.. ·
~ .•
ELECTRICAL
0 TEMPORARY SERVICE
0 ELECTRIC UNDERGROUND
0 ROUGH ELECTRIC
D POOL BONDING
D ELECTRIC SERVICE
0 CEILING HEAT
0 G.F.1.
0 SMOKE DETECTOR
D FINAL
MISCELLANEOUS
0 PLENUM AND DUCTS
D COMBUSTION AIR
0 PATIO
0 SIGN
0 GRADING
0 DRIVEWAY
0 CONDITIONED AIR SYSTEMS
0 REFER PIPING
D FINAL
READY FOR INSPECTION: □MONDAY □TUESDAY □WEDNESDAY □THURSDAY
DA.M.
oP.M.
SPECIAL INSTRUCTIONS ___________________________ _
REQUESTED BY __________________ PHONE NO. _ __,~-+-_,F.,_ __ _
I ;// .
PERSON TAKING REPORT_l,__ __ ~V ____ _
)
PLUMBING PERMIT APPLICATION .
City of CARLSBAD, CALIFORNIA 92008 •
Applicant to complete numbered spaces only. Phone 729-1181 Permit No. '
JOII AOOR CSS
LEOAL I locsc~.
LOT NO, I/_ .r( #/
OWN[" MAIL A00flt[S5
2
C. ' ,. -. , '/
tlP PHONC ,... -, .,
CONT .. ACTOR
3,
I MAIL ADOR£5S PHON [ STATE LIC. NO. CITY LIC. NO.
,tdtCHITt(T 0111 OCSIGNUt MAIL ADDRESS PHOM C LIC£NSC NO,
4
[NGIN[[flt 1, .. U.IL ADOR[SS PHOM[ LICENSE MO,
5
COMPENSATION (NS. CARRIER MAIL A.00 111(5$ IJlANCM
6
use Of" ft!JILDING
7 P,:-~ ./ ,
8 Class of work: CN.IEW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work:
PERMIT FEES
No.,. Type of Fixture or Item Fee
SPECIAL CONDITIONS: 7 WATER CLOSET (TOILET) $
~-j BATHTUB
lj LAVATORY (WASH BASIN)
,-.. SHOWER
KITCHEN SINK & DISP
DISHWASHER
APPLICATION ACCEPTED BY PLANS CHECKED ev APPROVE 9'-""R ISSUANCE SY 1---1--..:L::..A::..U:.N::....:D::..R_Y__:T_R_:A__:Y _____________ ~--+----
l , a CLOTHES WASHER
DAT~ ..2... WATER HEATER
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.
(DATE)
51GNAT"III£ o, OWNllll (I,-OWNEllt I UII.OERI OATC)
::r..
J
URINAL
DRINKING FOUNTAIN
FLOOR-SINK OR DRAIN
SLOP SINK
GASSYSTEMS NO.OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM ' SEWER NUMBER Cl.EAN0UTS '
CESSPOOL
SEPTIC TANK&. PIT
ROOF DRAINS
ISSUANCE FEE
TOTAL FEES
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
INSPECTOR
$ , t
$ I I , i
CASH
,I
0 0
ELECTRICAL . PERMIT APPLICATIONs
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 729-1181 Permit No C
7t?•• :t . '>l
., 7 -) J'L"JL..
JOB ADDlll £55 AL ~ r y ::, f . ' , i ./t~ 11'>1... I
LOT HO.
IOLK . I T"ACT l' ./lJ;,g_ L~GAL I Qst.£ ATTACHl.0 SHlltT ► 1 DUC~. / -
OWNC" //2 '/ r-/ t ,_ ~ c.;
MAIL ADD,.ESS "p PM ONE
2 ,, .. f//kt..l ~d s r. . ~
CONT"ACTOfll , MAIL ADDlllESS PHONE L.IC£NSE NO, STATE C I TY
3
A"CHITE(T 0(111 0£.SIGNUI MAIL ADDllllCSS PHONE LICtNSE HO.
4
ltNGINECllll MAIL ADDlll£SS PHONE LICCNSC NO,
5
COMPENSATION INS CARRIER MAIL ADOlllESS l"ANCH
6
use 0 ,-BUI LOI NG
7
8 Class of work : [SI NEW 0 ADDITION 0 AL TE RATION 0 REPAIR
9 Describe work:
PERMIT FEES
No. Each Fee
SPECIAL CONDITIONS:
ISSUANCE OF EACH PERMIT
2 r£...
-NEW CONSTRUCTION, FOR EACH
APPLICATION ACCEPTEO BY PLANS CHECICEO BY APPAOVEO FOR ISSU,\INCE BV AMPERES OF MAIN SERVICE, SWITCH, ...,,,. FUSE OR BREAKER -)(X) :.JO I@ ';J
' DATE k,..J NEW SERVICE ON EXISTING BLDG.
NOTICE FOR EA. AMPERE OF INC:REASE
IN MAIN SERVICE, SWITCH, FUSE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-OR BREAKER
TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A REMODEL, ALTERATION, NO CHANGE PERIOD OF 120 DAYl> AT ANY TIME AFTER WORK IS COM
MENCED. IN SERVICE, FOR EA. AMPERE OF
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS INCREASE
APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT, ALL PROVISIONS OF LAWS ANO ORDINANCE!> GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT TEMP. SERVICE UP TO AND INCLUD-PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE / 5. f!9 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
~ ./} TEMP. SERVICE OVER 200 AMP.
1 -PER 100
-at•NATUflll OP' CONTtlU,CTO" Ofl AUTt+OIIIIZ.10 AG~NT (OATCI
PERMIT FEE ~~7 og,,
■1awaTulU. OP' OWNE.111 IP' OWNER aulL.OC" OATI.
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. 1\11,0. CASH
INSPECTOR
MECHANICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. Phone 729-1181
-s., • 771 J• ••• Hl(~.co
Permit No.-n-~-~
JOB ADO .. tSS
....,. .. : F LR.,· I . ; l .✓t.A'11 A SI.
L.~GAl. I 1 one•.
LOT HO,
/1.-?
I T"AC T ,,,,., ,/,I/,.. 1 ,✓ . ,tf]s7£ATTACH£D SH££TI
C . //a,.r.~/lt ,._.w. /
OWNUI
2
/ CON Tlll:AC TOIi!:
3
Alll:CHITCCT o,-D[SIGHEft MAIL A00JltES5
4
CNGINEUI
5
LtNOEIII: MAIL AOOlll:£55
6
ust 0,. IUILDING
7 /'l
8 Class of work: 0-.N~w 0 ADDITION 0 ALTERATION
9 Describe work:
SPECIAL CONDITIONS.
APPLICATION ACCEPTEO BY PLANS CHECl<EO BY
NOTICE
r
APPROVEO FOR l~UAl'ICE BY ~-v ~
THIS PERMIT BECOMES NULL AND VOi DI F WORK OR CONSTRUC•
TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS,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 ANO EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANO 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.
-~-1, -,-,
(DATC)
•I.C.NATU"I' 01' OWN(" II' OWNE.fl autLOl" DATE.
ZIP PHONE
_) J(-{/ .,6
F'HON [ STATE LIC, NO.
.DHON [ LICENSE NO.
LICENSE NO,
SN.A.NCH
0 REPAIR
Type of Fuel. Oil 0 Nat. Gas O LPG. 0
PERMIT FEES
No. Type of Equipment
Air Cond. Units H.P. Ea
Refrigeration Units-H.P Ea.
Boilers H.P. Ea.
Gas Fired A.C. Units Tonnage Ea.
Forced Air Systems-B.T.U. j V M Ea.
Gravity Systems-B.T.U. M Ea.
Floor Furnaces-B.T.U. M
Wall Heatert B.T.U. M
Unit Hei.ters-B.T.U. M
Evaporative Coolers
Clothes Dryers
Ventilation Fan
Range Hood
Air Handling Unit-C.F.M.
Incinerator
/.
ISSUANCE FEE
TOTAL FEES
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
INSPECTOR
CITY LIC, NO.
Fee
$
$ , ro
CASH
MECHANICAL PERMIT• APPLICATION~···ze
...
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 7 29-1181 Permit No .,..TJJ/) It,~
JOI A00" E.SS
-. ' 0 1
LOT HO. I T,.ACT
,0 tOsct ATTAcwco SHECTI
..
OWHUI MAIL AO0fllCS9 21.
2 -. . • ---. -. ' PHON[
• .... d ) '-:'5
C:OHT,.ACTOllt MAIL AO01ftCS5 J
3 / ·-"• ... -t . ·•
PHONE lft~~ STATE LIC. NO. -,; ->--4"'... _oi: -... J ....
CITY LIC. NO. 1
AlltCHI TlCT 0 " Dt51GHt" MAIL AD0"£S5 DHON C LICENSE NO.
4
tNGINE.£." MAIL AOOAtSS PHO NC LICENSE NO.
5
LI.NOUI
6 ' ~ r • -
MAIL AOOll[SS _u l 213 .
US[ 0,-ISUILDIN(i
7
8 Class of work : □ NEW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work:
Type of Fuel Otl D Nat. Gas t3 LPG. D t PERMIT FEES
SPECIAL CONDITIONS: No. Type of Equipment I Fee
Air Cond. Units H.P. Ea. I $
Refrigeration Units-H.P. Ea. !
Boilers-H.P. Ea. I
Gas Fired A.C. Units-Tonnage Ea. -. Forced Air Systems-8.T.U. 0 IV..,
APPLICATION ACCEPTED ev PLANS CHECKED ev APPROVE O FOR ISSUANCE ev Gravity Systems-8.T.U. M Ea. t
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS,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 ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
~~ffJ~E0 ~o NGC:~E ~UETHGlR~~~i~g eroLi-tl'g~r~Aiiit ~~~
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
I I
SICNATU"ll 0,-CONT,U,CTO" Ollt AUTHO"tZlD AGENT l (DATE)
,
SIIC;HATtlfllr OP' OWNll" 'IP' OWNl:1111 au1LD[R' DATE.
Floor Furnaces-8.T.U.
Wall Heater:t-8.T.U.
Unit Heoters-B.T.U.
Evaporative Coolers
Clothes Dryers
Ventilation Fan
Range Hood
Air Handling Unit-
Incinerator
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.
INSPECTOR
M
M i'
M
C.F.M. I
ISSUANCE FEE s
TOTAL FEES s •.
M.O. CASH
t
f
I I
I
• t I I I
J
'\ • I\~ : 1 fi 'r
• ' t A I
1 • • \
\ . INTERDEP RTMENTAL INFORMATION SHEET
, ...... , ~
·j
RECEIVED
DATE=--Ll,rn,U..:A .... R-1--'o"---""'19 ...... z7~--J:ILDING ~\EPARTMENT ·~-.>-1,\~t (. '/ ~•
,J ~s-6r <t ..2~ 7 0 .
turLDING ADDREss = , 17, _ /7 .l} • eiTI,' eF eARLssAo ~ \_./ --1:~;~~~;-~-b(_;;(:z>.'-,F-,~--f7-·'...-<i7=-o--c-------P~B~u.~!ldpin~g-r-D;~p~a~rt~m~en~t~~~
3 @e17Zfe-4-2
PLANNING DE; ARTMENT . ~.
,• ·,·7.0NE_---,--!Z_-_7 ____ LOT SIZE ov-f'17~ LOT WIDTH___._-'-,
~J i I
' !~
'
' I.
I
l
I
t ►.
I l
,,
~JJNITS ALLOWED. UNITS PROVIDED 0 '·\,-.---------------~=----~~l-t€!9-fe
PARKING SPACES REQUIRED / z._ PROVIDED l ·~ • -----'--r-~~"f:,11-ofl
%/COVERAGE AL_C~~•lED -----~~-+z--'. cu..._ _____ PROVIDED L..~~-
BUILDING HEIGHT ·,ALLOWED PROVIDED ,1~-NJ, IMPEDIHG QR £JAltRn -., !.. •· : ) 1 '" trAr tuR,~G COllSTlu!
A
FLRLONOW~EDSETBAC.Jf;: i SIDE S&TBACK: RE~~~.iu,:
1
~S-~le .. l(-
. La l/;Z sr l lJ\) Z&~r~~""
PRol~DED -z.v · ·· (J( (!)I ~
IN;LsioNs 2"l}'A ... ~X 1 )J,tf-£71/\ i f1-r~i
LANDSCAPE & IRR~GATION PLAN COMMENTS: /.j,L)
ENVIRONf.lENTAL PROTECTION REQ: · t ., • --------------------' ~ "
FIRE DEPARTMENT
SPR INKLING SYSTEM FIRE PROTECTION EQUIP. -------------------
FIRE ALARHS EXITS _______________ _
FIRE HYDRANTS LOCATION _________________ _
ADDITIONAL COMMENTS
' OK
I
.UATER DEPA
:Ii
·I I
~ REQUIREME
';/' I
Owner's Name:
Mailing Address:
8erv1ce Address:
Tr~ct Description:
Type of Building:
Lateral Size: 4"
Extra footage:
Extra depth:
,,.--, \...-1.EUCADIA COUNTY WATER DISTRICT__,,
APPLICATION FOR SEWER SERVICE
Frank Newberr _y Phone No. 449-8900 ----'---------------
839A Del Mar Downs Rd.
Solana Beach
2566 Luciernaga St.
La Costa Meadows #1 lot 168
single family
:;i .r 'i/0 v -----------------..--J--I
6" 8"
@ $
@ $
No. Units
Saddle:
Ease.ment Connection
Connection Charge
Lateral Charge
Total
$500.00
-----
$500.00
The application must be signed by the owner (or his authorized representative) of the
property to be served. The total charges must be paid to the District at the time the
application is submitted.
If a service lateral is required, it will be installed by the Leucadia County Water
District. The service lateral is that part of the sewer system that extends. froin the
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. The applicant is responsible for the construction, at the applicant,s
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 connection of the applicant's building sewer to the service lateral shall be made
by the applicant at his expense. The connection must be made in conformity with the
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. THE APPLICANT, OR
HIS AUTHORIZED REPRESENTATIVE, MUST NOTIFY THE DISTRICT AT THE TIME INSPECTION IS DESIRED.
ANY CONNECTION MADE TO THE SERVICE LATERAL OR COLLECTION LINE WITHOUT PRIOR APPROVAL AND
INSPECTION BY THE DISTRICT WILL BE CONSIDERED INVALID AND WILL NOT BE ACKNOWLEDGED.
After connection is complete, the property described above is subject to a monthly
sewer service charge, billed bi-monthly in advance. The rate will be governed by the
use of the property, single family, multiple dwelling or commercial •. 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 co itions as stated:
6028
Date Account No.
---~·-----