HomeMy WebLinkAbout2911 Highland Dr; ; 70-215; PermitCITY OF tARLSBK
BUILDING DliPARTMENT
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.
BLOCK TRACT
USE OF
BUILDINGS
CONTRACTOR
ADDRESS
CITY
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
{/'
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER • $3.00
SEPTIC TANK, SEEPAGE PIT OR
PITS 0 $15.00
OVERFLOW SEEPAGE PIT, DRAIN,.lllLD EXTN.,
CESSPOOL, DRYWELL, MANHOLE • $15.00
HOUSE SEWER CONNECTING TO
PRIVATE D ISPOSAL SYSTEM @ $I.ISO
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER • $USO
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM O $2.00
• •
""
OWNER'S I PERMIT s 2
AUTHORIZATION TOTAL P'EE
r t'-J
00
I HAVE AT THIS DATE A CONTRACT W ITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD,
ING TO THE PUBLIC SEWER.
SIGNED THIS -----DAY OF ---------OWNER OR
OWNER'S AGENT-----------------
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION ANO STATE THAT THE ABOVE IS CORRECT
ANO AGREE TO COMPLY W ITH ALL CITY ORDINAN ANO
STATE LAWS REGULATING PLUMBING ANO SEW S. I HEREBY CERTIFY THAT I AM PROPERLY GISTEREO
ANO/OR LICENSED AS REQUIRED BY THE Cl OF CARLS-
BAD AND STATE OF CALIFORNIA OR THAT M THE LEGAL
OWNER OF THE ABOVE DESCRIBED RE ENTIAL PROP.
ERTY.
SIGNATURE
OF PERMITTEE
SEWER
PERMIT • APPLICATION
BUILDING
ADDRESS
NEAREST CROSS ST.
OWNER
MAIL
ADDRESS
CITY
CONNECTION DATA
Lateral Charge Computation
30' H .. 10' V. @ .. .. = ---6" ----
Add. Horiz. @ .. .. = ___ 6" ----
Add. Vert. @ .. .. = ___ 6" ----
Toto! Construction Cost
10% Servico Chorge
Totol Loterol Chorge ____ _
lot. No.: ____ _ Logged in Plot:
LINE COST DATA
A. D. & Assmt. No. ________________ _
LINE COST: _______________ _
C. C. @ ___ I dwelling ____________ _
P. S. @ __ I dwelling ____________ _
OTHER
TOTAL
Grond Totol, Loterol, etc.
FOR SEWER LOCATION
St.
ENGINEERING SEWER DEPT.
NORTH
Signed ________ _ Signed ________ _
Properly Filled Out, Signed and V•lid•t.d
l11ued By ------------------
PH MIT VALIDATION
CITY Of CARLSBF-:
BUILDING DEPARTMENT
FOR APPLICANT TO FILL IN
LEGAL DESCrllPTION l.OT N~O_. ______________ _
BLOCK TRAC~T _________ _
USE OF
BUILD INGS
CONTRACTOR
ADDRESS
C ITY -----TEL. NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK
HOUSE SEWER~ECTING TO
PUDLIC SEWEH @ $3.00
--~PTICTANK, SEEPAGE PIT OR PITS ____ @ $!5.0~_
--
ovc.RFLOVJ St:EPAG ... PIT. DF.:AINFIELO EXTN ..
--
CESSPOOL, ORYWELL, MANHOLE @ $5~ ___ _
HOUSE SEWER CONNECTING TO
__ ..,_P_R_I VATE DI SPOSA~TEM _ -~ _ $1. 50-t---l
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @ $1.50
ALTCR. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM ~2 o_o
OWNER'S
AUTHORIZATION
@_s __
I PERMIT s
TOTAL FEE
2 00
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD-
ING TO THE PUBLIC SEWER.
SIGNED THIS-'-----DAY OF---,-------
OWNER OR
OWNER'S AGENT~-~--------------
ADDRESS
I HERECY I\Cl~NOWLEDGE THAT I HAVE READ THIS
APPLIL/1 TIO,, /IND STATE T!iAT THE ABOVE IS CORRECT
AND AGl~EE TO COtlPLY 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 DESCRIElED RESIDENTIAL PROP·
ERTY.
SIGNATURE
OF PERMITTEE -------
SEWER
PERMIT • APPLICATION
CU·LDING ~~55:--______________ __:_ ____ _
NEAREST
CROSS ST
OWNER
MAIL
ADDRESS ----------------------
CITY TEL. NO.
CONNECTION DATA
Later~! Charge Computation
30' H., 10' V. @'. 4" ___ 6" =---
Add. Horiz. @ 4" = ___ 6" ----
Add. Vert. @ 4" = ___ 6" ----
Totol Construction Cost
10% Service Charge
Total Lotcrol Chorge ____ _
l~t. No.: _ Logged in Plot:
LINE COST DATA
A. D. & Assmf. No. ________________ _
LINE COST:
C. C. @ ___ / dwelling ____________ _
P. S. 'ii) ___ / dwelling ______________ _
OTHER
TOTAL
Grand Total, Loterol, etc.
FOR SEWER LOCATION
~1----------------1~
SEWER DEPT.
NORTH
This is a Sewer Permit W hen Properly Filled Out, Signed and Validated
Issued By _
PERMIT VALIDATION
V