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HomeMy WebLinkAbout2858 CARLSBAD BLVD; ; SE669496; PermitCITY OF%»I • ^Wi BUILDING DWARTMiMT PERMIT - A FOR APPLICANT TO FILL IN LEGALDESCRIPTION LOT NO. BLOCK USE OF BUILDINGS A » ^ CONTRACTOR VW?L*T i IT iVLftAjUOu'CM CONTRACTOR'S STATE LICENSE NO. TRACT Hi, "gj^y^feft. iXAi^ 1|Srts. . to .TEL. NoTl^/l *f| 1 O CARLSBAD BUSINESS LICENSE NO. NO. DESCRIPTION OF WORK FEE i HOUSE SEWER CONNECTING TO PUBLIC SEWER • S3.OO SEPTIC TANK. SEEPAGE PIT Oft PITS • *9.OO OVERFLOW CEEfAOE FIT. DK AIM FIELD EXTN., CUSI*OOU, DRYWEU-, MANHOLE f> *5.OO HOUSE SEWER CONNECTING TOPRIVATE DISPOSAL SYSTEM 9 *1.SO CONNECT ADDITIONAL BLDG. OR ALTER. REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM « S2.OO OWNER'S AUTHORIZATION 1 HAVE AT THIS DATE A CONTRACTOR TO CON NEC ING TO THE PUBLIC SEW SIGNED THIS OWNER'S AGENT ADDRFSS '. - .. • * PERMIT t TOTAL FEE 2 OO f oo CONTRACT WITH THE HEREINT THE ABOVE DESCRIBED BUILD- ER. - DAY OF 1 HEREBY ACKNOWLEDGE THAT 1 HAVE 1 APPLICATION AND STATE THAT THE ABOVE II AND AGREE TO COMPLY WITH ALL CITY ORDlW STATE LAWS REGULATING PLUMBING AND SIM1 HEREBY CERTIFY THAT 1 AM PROPERLY RAND/OR LICENSED AS REQUIRED BY THE CITY BAD AND STATE OF CALIFORNIA OR THAT 1 AM OWNER OF THE ABOVE DESCRIBED RESIDEN1 ERTY. SIGNATURE *EAD THIS S CORRECT U4CES AND WML EG1STERED OF CARLS-THE LEGAL IAL PROP- «U -|t)O iW '-"JiJW T"" • »• BUILDING (^ \fN ^5SW % ^Y\ NEAREST '—in ^ CROSS ST. OWNER ft ^ *. ADDRESS TL^&f (|tW\ft/Bir 'PSL4^ C'™(^/NAjL«.Jk- TE1~ NO. ^ CONNECTION DATA Lateral Charge Computation 30' H.. 10' V. <3> A" — A" — Add. V«rt. © 4" — . A" — 10% Sarvic« Charqn Tot-l UU«J <^.«j. LINE COST DATA A. n. A Affm*, N«. , , i IMF rn«;T; C, C, & / AfHMbHJ P. S_ & . / rJwotlinr] OTHFR . TrtTAI Sr-nd T«t.l. Ul^.1 -,. FOR SEWER LOCATION St. NORTH ENS1NEERINS SEWER DEPT. Si'gnflfi __ \ Cr^fiA^i Thb Is • S*mr fermH Wh«n Propcriy RIM Out, Signed «nd VaDdttad By PERMIT VALIDATION CITY Of CARLSBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION -1-66 FOR APPLICANT TO FILL IN LEGALDESCRIPTION LOT NO. BLOCK TRACT USE OFBUILDINGS CONTRACTOR ADDRESS BUILDING ADDRESS NEARESTCROSS ST. OWNER MAIL ADDRESS CITY TEL. NO. CITY TEL. NO. CONTRACTOR'S STATE LICENSE NO. CARLSBAD BUSINESS LICENSE NO. NO.DESCRIPTION OF WORK HOUSE SEWER CONNECTING PUBLIC SEWER FEE TO O $3.00 SEPTIC TANK. SEEPAGE PIT OR PITS * S5.OO OVERFLOW SEEPAGE PIT. DRAINF1ELD EXTN., CESSPOOL. DRYWELU MANHOLE 9 * 5.OO HOUSE SEWER CONNECTING PRIVATE DISPOSAL SYSTEM CONNECT ADDITIONAL BLDG WORK TO HOUSE SEWER TO9 S1.BO OR 0 St.SO ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 9 $2.OO « * OWNER'S PERMIT *AUTHORIZATION TOTA1_ PEE 2 OO 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 DAY OF ADDRESSI HEREBY ACKNOWLEDGE THAT 1 HAVE READ THISAPPLICATION AND STATE THAT THE ABOVE IS CORRECTAND AGREE TO COMPLY WITH ALL CITY ORDINANCES ANDSTATE LAWS REGULATING PLUMBING AND SEWERS.I HEREBY CERTIFY THAT I AM PROPERLY REGISTEREDAND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-BAD AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGALOWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP-ERTY.SIGNATUREOF PERMITTEE , . 1/5-CO go.oo CONNECTION DATA Lateral Charge Computation 30' H.. 10' V. Add. Horiz. Add. Vert. Total Construction Cost —_^ 10% Service Charge // /"'^M _ Total Lateral Charge Lot. No.: /^QC- Logged in_ Plat: LINE COST DATA A. D. & Assmt. No LINE COST: C. C. @ / dwelling P. S. @ / dwelling . OTHER „ TO TOTAL Grand Total, Lateral, etc. FOR SEWER LOCATION Thlf h a S»w«r Permit When Properly Filled Out, Signed and Validated limed By PERMIT VALIDATION