HomeMy WebLinkAbout110 SYCAMORE AVE; ; SE71-258; PermitCITY OF CARLSBAD SEWER •
BUILDING DEPARTMENT ;4-WrrroAJ IJ L L-1r,1z Z IH_ PERMIT. APPLICATION .--...
FOR APPLICANT TO FILL IN I T.D..b 25-7/ rdlj: 1 ZC/5 I .2..f.P
LEGAL BUILDING ' DESCRIPTION LOT NO. A DDRESS
BLOCK TRACT NEAREST
CROSS ST " -USE OF
BUILDINGS ---OWNER
MAIL
CONTRACTOR ADDRESS
A DDRESS C ITY TEL. NO.
C ITY TEL. NO. CONNECTION DATA
CONTRACTOR'S STATE CARLSBAD BUSINESS
LICENSE NO. L ICENSE NO.
Lateral Charge Computation
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 Total Construction Cost f
PITS @ --$5.~ ----OV£RFLOW SCEPAGE PIT, DRAINFIELD EXTN.,
CESSPOOL, ORYWELL, MANHOLE @ $5.00 10% Service Charge
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.50 Total Lateral Charge ----CONNECT ADDITIONAL BLDG. OR Lat. No.: Logged in Plot: WORK TO HOUSE SEWER @ $1.50 ----ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.00 LINE COST DATA --
@ $ 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 HEREIN
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 ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT T HE ABOVE IS CORRECT .... .... AND AGREE TO COMPLY WITH ALL C ITY ORDINANCES AND Vl V) STATE LAW S REGULATING PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED St. AND/OR LICENSED AS REQUIRED B Y THE CITY OF CARLS-NORTH BAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL
OWNER OF THE ABOVE DESCRIBED RESIDENTIAL
ERTY.
PROP· ENGINEERI NG SEWER DEPT.
S IGNATURE Sig nod OF PERMITTEE --I Signed
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By ____________________ _
PERMIT VALIDATION