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HomeMy WebLinkAbout1055 CARLSBAD VILLAGE DR; ; SE646233; PermitCITY OF CARLSBAD BUILDING DEPARTMENT _ SEWER PERMIT - FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO BLOCK USE OF .- BUILDINGS ' *> „ / / CONTRACTOR & s£_. ADDRESS <'r"Z_/V £-, ^CITY /£W/,V f tfj£l / (^CONTRACTOR S STATE T LICENSE NO 1 **-$ ty*~ -7 __ -^M S^ t TRACT •C t ~ & *> * X" ft' ft (~r&^n 3LSSC, t •> TEL NO -5T,? C?- 7 7X/' CARLSBAD/ BUSINESS LICENSE NO NO DESCRIPTION OF WORK FEE y HOUSE SEWER CONNECTING TO "7 XI / PUBLIC SEWER @ S3 OO _"5 rifj SEPTIC TANK SEEPAGE PIT OR PITS @ SSOO OVSRF-LOW SELHAGE PT DRAINFIELO EXTN CESSPOOL ORVWELL MANHOLE @ S5 OO HOUSE SEWER CO^ PRIVA I E DISPOSAL NECT1NG TO SYSTEM @ $1 SO CONNECT ADDITIONAL BLDG OR ALTER REPAIR OR ABANDON HOUSE SEWFR OR DISPOSAL SYSTEM @ 32 OO @ $ OWNER'S AUTHORIZATION ^A HAVE AT THIS DATE A ^FCONTRACIOR TO CONNEC , - i THE PUBLIC SEW w'VNtP OR -' JPPFjS PF'JMIT $ 2 OO TOTAL FEE ^ fj& CONTRACT WITH THE HEREIN 1 THE ABOVE DESCRIBED BUILD ER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS FPLIC, riOM AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS BAD AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER Of THE ABOVE DESCRIBED RESIDENTIAL PROP- ERTY x" s - - SIGNATURE /' / ^ - //X -T -~~~ • BUILDING Xyr-j s — T~~ ~ /r- , C-.C- ADDRESS 'C' *~> -i C> £— Ss/ O f NEAREST CROSS ST OWNER ji-T1 /^^.' C f 7 "7~XV~7 XX.X"'' Z£& MAIL / — s- ADDRESS A*^" (T~ /--X^//^7/^/^ f /T7 : f >*• fC CITY ^^-/U r^)/(_ ^Q TEL NO CONNECTION DATA Lateral Charge Computation 30 H 10' V CD 4" — /," — Add Verr 0 4" — t," — I0°/n ^flrv rf, Chnrrjfl Lat No . Logged in Plat LINE COST DATA A D & Assmt Nn 1 IMF C.C,^ C C. (<t) / ^w^llmr, P S (ft / r(«/pflm0 OTHPR TOTAI FOR SEWER LOCATION St NORTH ENGINEERING SEWER DEPT Sinnpr) I ^ifjn^ ' This is a'Sewer Permit When Properly Filled Out, Signed and Validated i«n«rJ Ry PERMIT VALIDATION