HomeMy WebLinkAbout2855 CARLSBAD BLVD; ; SE669422; PermitSBHf»
PERMIT -APPPCATIOH
FOR APPLICANT TO FILL IN
LB9AL
CRSCR1PT1ON LOT NO,IM!?U.
COrfTRACTOR'S STATELICENSE NO.CARLSBAD BUSINESSLICENSE NO.
;fllPTIpM-<ffi|iyol$K7 FEE
HOWSffi SEWER CONNECTING TO
PUBUC SEVJEJC ; lli^j OSj-OO^
SEPTtC TAN|T«BEilAOE PIT OR
* *».00
OVERFLOW lEKPAOV WT, e%Al«FlKLD EXTN.,
GE8gJt<§OU. pBt^9ft4.i»j^'HPm O »5.OQ
liittHOUSt SEWSW!OPPRIVATE CT1HG TO
ALTER. REPAIR
EEWER Oft DI
NDON HOUSESYSTEM O $2.OO
» »
A«tHOM»TION
;Pg«MIT 00
I HAVE AT THIS DATE Ai CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD.
ING TO TH6 PUBLIC SBVtllt.
3i«NED THISowr OAY <a
OWNER'S AOEUT
s
? HEREBY
APPfclCATlOp*
A?JS> AGREE I'D
STATE LAWS UAT1H
AWp/CtR LIQBNSED AS Rgj
BUFAND SWE OF "" *
?HAT I HAVE READ THIS
THE ABOVE IS CORRECT
ALL CITY ORDINANCES AND
UPBHNG AND SEWERS.llKl PROPERLY REGISTERED
BY THE CITY Of CARU8-
OR THAT I AM THE LEGALRESIDENTIAL PROP-
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V.
Add. Horii.
Add. Vert.
10% 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
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
St.NORTH
ENGINEERING SEWER DEPT.
Signed Signed
n Properly Riled Out, Signed and Validated
PERMIT VALIDATION