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HomeMy WebLinkAbout265 CHINQUAPIN AVE; ; SE669053; PermitCITY OF CARLSBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO BLOCK TRACT USE OF BUILDINGS CONTRACTOR ADDRESS CITY TEL NO CONTRACTOR S STATE LICENSE NO CARLSBAD BUSINESS LICENSE NO NO / DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 OO SEPTIC TANK SEEPAGE PIT OR PITS @ *5 OO OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 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 @ 9 OWNERS AUTHORIZATION PERMIT $ TOTAL FEE 2 *F f>ft 00 ~t>f5 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD ING TO THE PUBLIC SEWER SIGNED THIS OWNER OR OWNER S AGENT . ADDRESS DAY OF . I HEREBY ACKNOWLEDGE THAT I 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 I 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 V, PERMITTEE/^!OF PAID.Qp^r FEB-866 5!rr1085*******500 C1TY CONNECTION DATA Lateral Charge Computation 30 H 10 V Add Honz Add Vert IO/ Service Charge Lat No Total Construction Cost Total Lateral Charge Logged in Plat LINE COST DATA A D & Assmt No LINE COST C C © / , / dwelling P S @ / dwelling _ OTHER .cV \\ TOTAL Grand Total Lateral etc FOR SEWER LOCATION St NORTH ENGINEERING SEWER DEPT Sianed . This is a Sewer Permit When Properly Filled Out Signed and Validated Issued By PERMIT VALIDATION OJY Of CAftUBAD BUfLCflKlG DEPARTMENT •SEWER PERMIT. APPLICATION FOR APPLICANT TO FILL IN 1 LEGAL /= a, - ^ — --~DESCRIPTION LOT NO /T"» «. J^*"/^ (V"5 BLOCK "^T** USE OF BUILDINGS TRACT/"^ . t A£^^ 4A"4 • <2£ CONTRACTOR ADDRESS CITY CONTRACTOR S STATE LICENSE NO NO DESCRIPTION OF TEL NO CARLSBAD BUSINESSLICENSE NO WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 9 $3 OO SEPTIC TANK SEEPAGE PIT OR PITS (9 $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE 9 $5 OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 5O CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $1 5O ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 9 $2 OO OWNER S AUTHORIZATION 1 HAVE AT THIS DATE A CONTRACTOR TO CONNEC ING TO THE PUBLIC SEW SIGNED THIS OWNER OR ADDRESS 9 $ PERMIT 9 2, OO TOTAL FEE CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD ER DAY OF 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREED 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 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP- ERTY SIGNATURE ADDRBwfef&T <CjtttM&6^&&(S NEAREST ^*\ CROSS ST /^L^klf ffS-fJLfcJ OWNER &tS j£ C^G^t^fft^ ^CC* J» * •— ""•ADDRESS '•>.*9'^SS CITY t^fV/g^Sid^^P TEL NO CONNECTION DATA Lateral Charge Computation 30 H 10 V <S> 4 — A" — Artrl HnriT (S) A A" Add Vert © 4" — A" — Tot<i| Construction Cost.. _._._.__ 10 ^ Service Charge „ Tot-i i ,t«r,i r.k^r «^^^S Lat No . .. Logged in Wat LINE COST DATA ^ A D & Assrnt No ^-€X /*"f^»£>i L1NF COST /^ C C sT y dwBll,n0 *^sS£&C^! PS® / dwnllmn OTHFR jt TOTAl jS/^T, ^C FOR SEWER LOCATION St / NORTH ENGINEERfN© / SEWER DEPT Srgnnfi . .s&^^^fijjnnfl'-! Ir l"^*^ This is a Sewer Permit When Property _Wfeji, Out Signed and Validated PERMIT VALIDATION