HomeMy WebLinkAbout2653 ROOSEVELT ST; ; SE669051; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION LOT NO.
BLOCK TRACT
USE OF L"\ . 0
BUILDINGS ~ -
CONTRACTOR ~ --£,"-..,) '\
ADDRESS
CITY TEL. NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 13.00 ,
SEPTIC TANK, SEEPAGE PIT OR
PITS 0 111.00
OVERFLOW SEEPAGE PIT, DRAINl"IELD EXTN.,
CESSPOOL, DRYWELL, MANHOLE O $15.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 0 $1.150
CONNECT ADDITIONAL BLOG. OR WORK TO HOUSE SEWER 0 $1.150
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM O $2.00
0 •
OWNER'S PERMIT s 2
~
00
AUTHORIZATION I TOTAL l"EE <"rµ
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 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLIC ATION AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
ANO/OR LICENSED AS REQUIRED BY THE ITY 01" CARLS-BAD AND STATE OF CALIFORNIA OR THA I AM THE LE L
OWNER OF THE ABOVE SCRIBE!2.-,N;U~NTIN,_,!.l"'"';P.
ERTY.
SIGNATURE OF PERMITTEE
Properly
BUILDING
ADDRESS
NEAREST
CROSS ST.
OWNER
MAIL
AOORESS
CITY
SEWER
PERMIT • APPLICATION
'SPAID rE9 -8-66 _ cc108Z*******S.OO
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V. @ 4" = --b"=--
Add. Horiz. @ 4" __ 6"=--
Add. Vert. @ 4" = __ b"=--
Totol Construction Cost
10% Service Chorge
Total Loterol Chorge _,_-'-"....,,_~,....
Lot. No.: Logged in Plot:
LINE COST DATA
A. D. & Assmt. No. -----~tc---r---.....-----
LINE COST: ---------1---+---4-+-----
C. C. @ __ / dwelling ---./--\-...:::-:f=.:::jt"-:+====--
P. S. @ __ /dwelling ------'=----1---_,.__ __ _
OTHER __________________ _
Signed
Grand Totol, Loterol, et
FOR SEWER LOCATION ~1----11~
NORTH
SEWER DEPT.
Signed ________ _
l11ued By -------------------
PERMIT VALIDATION