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Home My WebLink About2721 La Gran Via; ; 77-1579; Permit' MODEL ND. __________ _ ) ' _.. BUILDING PERMIT APPLICATION City of CARLSBAD, CALIFORNIA 92008 Phone 729-1181 --, l fS-79 Applicanr to complete numbered spaces only. Permit No. JOI ADD"£~~ ASSESSOR'S ~74/ '} PARCEL NUMBER /A ~Pf,-t. ·L 1..0T NO, I ... I TRACT BOOK PAGE I PAR. LtcAL I -. -... -Osct •Tr•c.-.co SM(tTI 1 OCSC.111:. 1 .,. __ . ----. OWN Cllt 1,,u.1 L AODllltSS ZIP ,---. .:: PHON[ 2 l ,1 ...... 1 •• 1 • • .A ?55-1 ) --· .. ,,._,. CON T"AC TOIi!: MA L ADOlllC5S r~t~-tr I ~~· __.. Pt40N .. -.-;.;;;. . . STATE LIC. NO. CITY LIC. NO. -- 3 ~ y • 12 B. , t., 0 nfln ~--.... h -• Allt(HI T[C T 0" OCSICNCIII MAu • .a.00111:css PHOM£ LIC[N5( NO 4 al 'JI C [NGINtE.R MAIL AOOA CSS PHONt LICC,.5[ NO, 5 , COMPENSATION INS, CARRIER MAIL A00"C.5S /~'" 6 -.o. X 20 • • • 92112 F? , USE 0,. 8.JILOING 1 1 e 1 11 NO. BDRMS ) NO. BATHS 2 8 Class of w ork: ~NEW 0 ADDITION 0 AL TE RATION 0 REPAIR 0 MOVE 0 REMOVE /} 9 Describe w ork: -~--tw blf.ib, • stlltft~• --~/q /\t I'-' • /I --------------• -(!JP" af ..J v--1~/ I I 10 Change of use from I q/(/ Change of use to 11 Valuation of work: $ I ( .:__j PERMIT FEE S / I ....,J.._,),/ I -PLAN CHECK FEES -- SPECIAL CONDITIONS Jr-JI MICRO FILM FEE Type of Occupancy 1-::r -Const Group Sile of Bldg ~ No. of I Max (Total) Sq Ft 'Oo3 Stories 0cc. Load Fire 3 use R..-I Fore Sprinklers APPLICATION ACCEPTED ev PLANS CHECKE OBY APPROVED FOR ISSUA"'4CE av Zone Zone ReQuired D Yes □No No. of OFFSTREET PARKING SPACES DATE Dwell,ng Units No. Sq, Ft. 576 l~~en DATE Covered 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 AND VOID IF WORK OR CONSTRUC· TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF FIRE DEPT CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT PERIOD OF 120 DAYS AT ANY T IME AFTER WORK IS COM- MENCED OTHER (Specify) I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ENGINEERING DEPT ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WATER DEPT. HEREIN OR THE, GRANTING OF A PERMIT DOES NOT NOT, PRESUME T O G IVE, AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION pR THE PERFORMANCE OFi CONSTRUCTION. \ ~ ~ 7 I SlGNA TUfllC a,. t6NTll'tACTON Oll't AU.TMOll'lll[D AGENT (DATC) . ~11:HATUl'C Ot' OWN[,-IP' OWNClll I UILDl.flll) OATC) WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH TOTAL FEES $ _____ ( ____ -_ INSPECTOR FOUNDA" SET INSPECTION RECORD , ...... I REQUEST FOR ' -('J • A TRE REIi FOU WEil 0,r.JW INSPECTION TIME w · So \. r1 · Inspector ...... R~ ....................... Pe,mlt No.·················-·········· Dote ... 1_:..l.CJ.=.'7_1 Owner __ V\/....!----'--b(A"'=...,*Q.~~,'-lb"-',1------------------ CONCREl FRAMING INT. LAH EXT. LAT MASONR't FINAL USE SPACE Address .. :}: '1 l \ \-0= ~ ~ \) l C. . BUILDING PLUMBING ELECTRICAL MISCELLANEOUS Insulation ................. D .................................. □ ................................ D Plenum & Ducts ....... D Drywall .................... D Gas .......................... D Pool Bonding .......... D Porch ........................ D Fdn. Forms .............. D Water Heater ............ D Temp Pole .............. D Patio ........................ D Steel ........................ 0 Sewer ................ 0 ................... □ Driveway .................. □ Sheathing ................ D Undergrnd. Plbg ....... D Underground .......... D Sign .......................... D Lath .......................... D Undergrnd. Water .... □ Ceil Heat .............. O Wall .......................... D ~me ..................... :_g1 h ..................... □ .................... 0 Fence ...................... 0 ~al ············;···········~Final ............ . ... ~------,~Grading .................... D Requested by .. .... . . . . ..... . ... ·-·~·-········ ,-.,1 0 Phone number .... Lt-it;.:...-···i··~·-.. ···?'········· Person Taking Report: .. ..v.-r··························· 4-7-77 Fdn. forms: O.K. B. NElson 4-8-77 Pour: O.K. E. Plude ______ 6-6-77 Sheathing: O.K. B. Nelson '"C,OR -- - - PLUMBING PERMIT APPLICATION l1573 ittt•~ $7.~ City of CARLSBAD, CALIFORNIA 92008 Applicant to complete numbered spaces only Phone 729-1181 Permit No 7 7 -,:;,i-~,o)_/ JOB ADDA CSS i-A : ltr1 ,::!'/ t[J I c. ~k-lfiV ccm I l.OT NO'_/ I I OLK I T~Z.,f UJsr,1 { 11 AJ/JOII 1 DUC~. -=jJ own~.r . ,a MAll,l·,.oolll£SS /3,t.//D ft Lill /JIL ""r/!;6-,g/~?, 2 ',I;/// .. "' _/111..Sl/6,, l@:Jt < ·c I/ 'o/" ~--.,'.5,) CON T,u,c TOIII V ~.<.P--t MAIL ADDRESS t;~~ PHO.Ht. -I".,,. STATE LIC, NO. CITY LIC. NO. 3 ~ /g5-/ , ..... , --_, .. --· -, /7;~{ o~Jrr;f~AJEIJ & I M?lJl/•st~ tl-,-A ~ t-7't£ I -8/.t;~ LICCNSC,~ 'J. 'I I . . 'O CNGINCCIIJ 7 ._,.AH. ADOfltlSS \VJL/l"Nn -~ PHONE LICENSE NO. 5 COMPENSATION (NS. CARRI ER MAIi.. AODlll!,IS ~ BIU,NCH 6 ·---- US[ or 9Vll.OINC I 7 8 Class of work: EW □ ADDITION 0 ALTERATION □ REPAIR 9 Describe work: PERMIT FEES No. T ype of Fixture or Item Fee SPECIAL CONDITIONS· ~ WATER CLOSET (TOILET) $ BATHTUB J LAVATORY (WASH BASIN) I SHOWER -•. I KITCHEN SINK & DISP ~ /I DISHWASHER .APPUCA TION A<;GEPTE D 8¥ f PLANS CHECKED SY APPROVED •D~ANCE BY I LAUNDRY TRAY ( I CLOTHES WASHER // ✓ WATER HEATER I A~ OATE NOTICE URINAL THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC . DRINKING FOUNTAIN -T ION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF / l"t'ouR-SINK OR DRAIN • ~ CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A ) PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-SLOP SINK MENCED. GASSYSTEMS NO.OUTLETS I ., I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO Bf TRUE AND CORRECT , WATER PIPING & TREATING EQUIP. _, ( r... ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS ,. . TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WASTE INTERCEPTOR HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE ., VACUUM BREAKERS PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. I LAWN SP~INKLER SYSTEM -~ C . SEWER NUMBER CLEANOUTS ), J. I "k. lr-vmt,-CESSPOOL / // SEPTIC TANK I, PIT -17 ROOF DRAINS SIGNATUfU. o, CONTfltACTO" OJI: AUTMO"IZED AGENT (OATEI ISSUANCE FEE $ ' TOTAL FEES SIGNATUIIU: OP' 0WNl'.llll: 11, 0WNC!llt IUILDCNJ OAT[) $ ·'T!2' WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT ,c PLAN CHECK VALIDATION CK . M.O. CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR 7 7 -;2.D .;;-f --- INSPECTION REPORT s DATE r ITEM REM ARKS INSPECTOR - -+ -~ --- --- ----+- f ~----- - -,_ USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. /" 4-4-77 Underground Plbg. O.K. B. Nelson ' ' 0 ELE TRICAL PERMIT APPLICATION City of CARLSBAD, CALIFORNIA 92008 1 ~ oa Applicant to complete numbered spaces only Phone 7 29-1181 Perm it No -n... -6Y '?() I JO• .-,0011t tSS { ~/.-I'/ ,, ,..,; -/, ~ /1/..,r'...-( I'•''-~.,, ~~ -,.;' . LOT NO, Im I T•At T ' Qstt ATTACHED SH[l.T) LCS4L I 1 ouc•. OWNUII /.; _/,, ~ L MA.IL AOOIU.SS 21 p PWONl 2 -,~ A ("" CONT,.ACTOII ~Y' ,r_h!-,✓'h ~ MA.IL AODIIESS PHDHC / 2•/~ ~,i.. •LICCHSC NO, STATE: CITY 3 2./;' ?/b~,c✓~ -~·. ;,_// ~ 7'/1 /_<:"', 1 -J ~fl'?.. A"CHITI.CT 0,it Dl.SIGP•U:" MAI L AODJltas ,iHOHl. •F.v LICENSI. HO, 4 I.NGINEtllt MAIL ADDIIIIESI PHONI. LICENSt HO. 5 COMPENSATION INS CARRIER MAIL AOO"tss ■"ANCH 6 US( o, aulLOING 7 -~ .. ~ , .. -. ,._ - 8 Class of work: □NEW 0 ADDITION 0 ALTERATION 0 REPAIR 9 Describe work: PERMIT FEES No. Each Fee SPECIAL CONDITIONS: ISSUANCE OF EACH PERMIT ~,,:. 'i -J NEW CONSTRUCTION, FOR EACH . AMPERES OF MAIN SERVICE, SWITCH, 41'f'LICATION ACCf,TEDBY 'LA"S CHECKED BY APPROVEO FOR ISSUANCE BY FUSE OR BREAKER --~ .) < ◄ r:, DATE NEW SERVICE ON EXISTING BLDG. NOTICE FOR EA. AMPERE OF INr.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 DAY!> AT ANY TIME AFTER WORK IS COi\.~ MENCED IN SERVICE, FOR EA. AMPERE OF I HEREBY CERTIFY THAT 1 HAVE READ ANO EXAMINED THIS INCREASE ·~, APPLICATION AND KNOW THE SAME: TO BE TRUE AND CORRECT. .... 1-, ALL PROVISIONS OF aAWS ANO OROJNANCE!> GOVERNING THIS -TYPE OF WORK WILL Bir 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. .//2/ . ;() TEMP. SERVICE OVER 200 AMP. PER 100 rl✓✓ -¥-I~/ 77 Sl9NATU"C or COkT,tACTOJI Ofl AUTHOJllllD AGI.NT (DA Tl I PERMIT FEE 117. ,1"0 ., TI •• I[ or OWN " ,,. OWN[" IUILD[JI) (DATl ' WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR INSPECTION REPORTS DATE ITEM REMARKS INSPECTOR . USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. Temp. O .K 6-3-77 O 0 ELECTRICAL PERMIT APPLICATION Permit No. _____ _ Applicant to complete numbered spaces only. City of CARLSBAD, CALIFORNIA 92008 Phone 7 29-1181 Joa ADOIII ESS ' LOT NO. 1 ~~=~~-■LK TIIACT O •tr. ATTACHI.D .SHCI.T) OWNUI MAIL A00111ESS %1~ PHONlt 2 ., CONTIIIACTOIII MAIL A0O111£SS 'HONI: cl LICtNSE NO. 3 Co 124 AIIICHITECT OR DE.SIGNUI MAIL ADDRESS 4 1'..NGINI.Cflt MAIL ADO"ESS 5 Ll:NOl:II MAIL AOOIIIESS 6 uat OP' aulLOING 7 8 Class of work: 0 ALTERATION 9 Describe work: SPECIAL CONDITIONS: A"'LICATION ACCEPTED BY PLANS CHECKED BY APPROVE O FOR ISSUANCE BY NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- TION AUTHORIZED IS NOT COMMENCED WITHIN 60 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 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. SI.NA.Tu•& OP' CONTWIACTO" '" AUTMOflll&CD AGI.NT (DATU T " 0,-OWN ti IP' OWN£" 8UILDE.Pl DATI h 6 ,HONE LICENSE NO, ,.HONE LICENSE NO, IIU,NCH 0 REPAIR PERMIT FEES ISSUANCE OF EACH PERMIT NEW CONSTRUCTION, FOR EACH AMPERES OF MAIN SERVICE, SWITCH, FUSE OR BREAKER NEW SERVICE ON EXISTING BLOG. FOR EA. AMPERE OF INCREASE IN MAIN SERVICE, SWITCH, FUSE OR BREAKER REMODEL, ALTERATION, NO CHANGE IN SERVICE, FOR EA. AMPERE OF INCREASE 'TEMP. SERVICE UP TO AND INCLUD- ING 200 AMP. TEMP. SERVICE OVER 200 AMP. PER 100 MINIMUM PERMIT FEE No. Each WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK. M.O. INSPECTOR Fee CASH 0 t z " 11 "U ~ (l) ~ 3 ► -· 0 ... 0 "2 ::o .. . - 7?-ts0 . . INSPECTION REPORTS DATE ITEM REMARKS INSPECTOR USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC. I 4··15-77 ~emp . I:lec . O.I~. E. nelson .. .. '?" / MECHANICAL PERMIT APPLICATION City of CARLSBAD, CALIFORNIA 92008 Applicant to complete numbered spaces only J:;,~DDft~/ LA f.//PJ1A.. I/ii} Phone 729-1181 Permit No LOT NOdl~ / &LK \ I Tlit ~I} i!ANIJlYI-tOscc ATTACHED SHCCT) LCUL I 1 DUCft, OW,Ht_ft] (J/!11&!;£ ~$xi°1~11u utfi!M ·fd!l_,¢ i74_',-g/% 2 . fJn. CONT .. ACTO,. MAIL ADDRESS PHONC STATE LIC, NO. CITY LIC, ND, 3 1 t ;;r;~c)IJ/i:fiJ6(/JC!a w € t~;;;; :»t.11/tf! l1NI -~/-"[/42~ LICCN5/?(JO¢ [NGIN[CJIII .._/ MAIL AOOIIIESS PHON[ LICE.NS[ NO, 5 LINDE.JIii ... f ~ fAq MAI L AOO"ESS BRANCH 6 I use 011" BUILDING 1 . \ D 8 Class of work: c¾Ew 0 ADDITION 0 ALTERATION 0 REPAIR 9 Describe work: ~ \Q.::,,Z,(l t¾ rt_ \C2,A 11-I TILE 12.c. b r:: ~'\UC t. <..-~JLT£1'L I ( ,· J I --"' Type of Fuel. Oil D Nat. Gas D LPG. D PERMIT FEES SPECIAL CONDITIONS No. Type of Equipment Fee Air Cond. Units-H.P. Ea. $ Refrigeration Units-H .P. Ea. Boilers-H.P. Ea. Gas Fired A.C. Units Tonnage Ea. f Forced Air Systems-B.T.U. M Ea. '-1 ~c.· A,PLICATION ACCEPTED BY PLANS CHECKED BY APPROVE O FOR ISSUANCE BY Gravity Systems-B.T.U. M Ea. r _,) J! Floor Furnaces-B.T.U. M Wall Heater~-B.T.U . M NOTICE Unit Heaters-B.T.U. M f, THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-Evaporative Coolers TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS,OR IF /; Clothes Dryers -;J._ -CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-/. Ventilation Fen '2-_;...... MENCED. , Range Hood ,.( l C I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. Air Handling Unit-C.F.M. -ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED Incinerator _ .. HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT -PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE / ~ . .✓ LJ,,,-;:-. r...,. ~ e;.v PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. r ik--k,,,c f, ~---:o -77 . { C \... . . ',. t <c __ . SIG~A..TU"C 0,, CONT"ACTOIII 0" AtTHOlllll.EO AGENT (DATE.) ISSUANCE FEE s I -.i alC.HATU"I: o, OWNUI 1, OWNE.1111 9UILDI:") DATll TOTAL FEES s It:, WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH INSPECTOR l - INTERDEPARTMENTAL INFORMATION SHEET BUILDING DEPARTMENT BUILDING ADDRESS: • I ..... •·r .,! -t-7,? PLANNING DEPARTMENT • ZONE tt 7500 LOT SIZE _ __,1£'->oooo<.....:c...-='-----LOT WIDTH_ .... ?C~----- UNITS ALLOWED UNITS PROVIDED ---~-------------------- PARKING SPACES REQUIRED 2---. PROVIDED __ *_L_+-------- % COVERAGE ALLOWED ~ PROVIDED _ BUILDING HEIGHT ALLOWED _3_~S{ _______ PROVIDED FRONT SETBACK: / AJ,LOWED 20 P~ovIDED 2 o1 ,,,,~-INTRUSIONS l-~ LANDSCAPE & IRRIGATION PLAN ENVIRONMENTAL PROTECTION REQ: . . ,ApDITIONAL OK TO ISSU ENGINEERING DEPARTMENT RRARE"'" SIDE SETBACK: 5.f .... i~A.__ ___________ '! R.O.W. f?y;,.,:t, IND R AL WASTEAhf At-6/!iC:: IMPROVEMENTS f:5-;s"i: SEWER CONNECTION L DRIVEWAY 1 ~0CATIONSt'~ /!,,fJ,aj. B:-,,,,-,;-ffet{,t GRADING PERMIT~,•'./. 7""e'EASEMENTS -le.-,e, DRAINAGE J/. l#,•11, ~UIO~ LEGAL DESCRIPTioNLe:f: 0 ?z C:&c-'DI e.....,.,..,./4 I~~ 7z_c5= 'ADDITIONAL COMMENTS ~ ~•---& -"1'W ?6? • J,. _,,.,,. , !I • ... FIRE DEPARTMENT ( SPRI!iKLING SYSTEM ~----------FIRE PROTECTION EQUIP. ______ _ FIRE ALARMS EXITS ______________ _ FIRE HYDRANTS LOCATION ________________ _ ADDITIONAL COMMENTS ----------ca::----=---------------- OK ______ DATE ____ _ ,:,WATER DEPA ' REQUIREMEN _____ DATE _______ _ • ' / LEUCADIA COUNTY WATER DISTRICT APPLICATION FOR SEWER SERVICE Owner's Name: _ __JM,.au]l.l.Pw015,e~y_C"'o,l.lmlll'-'!J..IJ--------------Phone NO. 481 -8626 Mailing Address: ____J_2u4c.J.E~,_,,C_.LL·LL--------------- Solana Beach 92075 Service Address: La Gran Vi a TrRct Description: lot l La Costa Canada Type of Building: single family No. Units __ _ Connection Charge$500.00 Lateral Size: 4" 6" 8" Saddle: Extra footage: ___ @ $ __ _ Easement Connection __ _ Extra depth: ____ @ $ __ _ Amount Rec'd$ 500.00 How Paid ck#l797 Date Paid 3-2-77 Rec'd b J. Geiselhart . boe~J Lateral Charge Total $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. that the above information given is correct and agrees to 6169 Account No.