HomeMy WebLinkAbout2775 CARLSBAD BLVD; ; SE658340; PermitCITY OF
BUILDING DEPARTMENT
8340 SEWER
PERMIT - APPLICATION
•AID
FOR APPLICANT TO FILL IN
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO.DESCRIPTION OF WORK
HOUSE SEWER CONNECTING
PUBLIC SEWER
FEE
TO9 93,00
SEPTIC TANK, SEEPAGE PIT ORPITS • $8.00
OVERFLOW SEEPAGE PIT. ORAINFIELD EXTN,,
CESSPOOL., DHVWELL. MANHOLE 9 »5.OO
HOUSE SEWER CONNECTING
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG
WORK TO HOUSE SEWER
TO@ $1.5O
OR9 $!-3O
ALTER. REPAIR OR ABANDON HOUSESEWER OR DISPOSAL SYSTEM 9 $2.OO
9 $
OWNER'S PERMIT *- AUTHORIZATION TOTM. FEE
/
Z
3
*b
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD-
ING TO THE PUBLIC SEWER.
SIGNED THISOWNER OROWNER'S AGENT
DAY OF
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THISAPPLICATION AND STATE THAT THE ABOVE IS CORRECTAND 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-WE CITY OF CARLS.
BAD AND STATE OF CALIMfiKlApwifiAT ' AM THE LEGAL
OWNER OF THE ABOVEWlBROSB RESIDENTIAL PROP-
SIGNATUREOF PERMITTEE
CONNECTION DATA
Lateral Charge Computation
30' H.. 10' V.
Add. Horiz.
Add. Vert.
10% Service Charge
Lot. NO.T
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
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
St.NORTH
ENGINEERING SEWER DEPT.
Signed Signed
This awer Permit When Properly Filled Out, Signed and Validated
limed By — . -
PERMIT VALIDATION