HomeMy WebLinkAbout2727 ROOSEVELT ST; ; SE700197; PermitCITY OF CARLSBAD . ,. SEWER
BUILDING DEPARTMENT PERMIT. APPLICATION
FOR APPLICANT TO FILL IN
LEGAL BUILDING DESCR IPTION Lo·r NO. ADDRESS
BLOCK TRACT NEAREST
CROSS ST.
USE OF
BUILDINGS OWNER
MAIL
C ONTRACTOR A DDRESS
ADDRESS C ITY TEL. NO.
C ITY TEL. NO. CONNECTION DATA
CONTRACTOR'S STATE CARLSBAD BUSINESS Lateral Charge Computation
LICENSE NO. LICENSE NO.
30' H., 10' V. @ 4" = ___ 6" -----
Add. Horiz. @ 4" -___ 6" -NO. DESCRIPTION OF WORK FEE -----
HOUSE SEWER CONNECTING TO Add. Vert. @ 4" = ___ 6" -PUBLIC SEWER @ $3.00 ----
SEPTIC TANK, SEEPAGE PIT OR
PITS @ $!5.00 Total Construction Cost
OVERFLOW SEEPAGE PIT, ORAINFIELD EXTN., 10% Service Charge CESSPOOL, DRYWELL , MA NHOLE @ $!5.00
HOUSE SEWER CONNECTING TO Total Lateral Charge PRIVATE DISPOSAL SYSTEM @ Sl.!50
CONNECT ADDITIONAL BLDG. OR Lat. No.: Logged in Plat: WORK TO HOUSE SEWER @ $1.!50
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.00 LINE COST DATA
@ s A. D. & Assmt. No.
LINE COST:
OWNER'S I PERMIT s 2 00 C. C. @ ___ I dwelling
AUTHORIZATION TOTAL FEE P. S. @ __ / dwelling
OTHER
I HAVE AT THIS DATE A CONTRACT WITH THE H EREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD· TOTAL ING TO THE PUBLIC SEWER.
SIGNED THIS DAY OF Grand Total, Lateral, etc.
OWNER OR
OWNER'S AGENT FOR SEWER LOCATION
ADDRESS
I HEREBY AC KNOWLEDGE THAT I HAVE READ THIS
A PPLICAT ION AND STATE THAT T H E ABOVE IS CORRECT ... ... AND AGREE TO COMPLY W ITH ALL C ITY ORDINANCES AND V) V) STATE LAWS REGULATING PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED St. AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS-NORTH BAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL
OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP· ENGINEERING SEWER DEPT. ERTY.
S IGNATURE Signed -I Signed OF PERMITTEE
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By ____________________ _
PERMIT VALIDATION