HomeMy WebLinkAbout1197 CHESTNUT AVE; ; SE668823; PermitCITY OF CARLSBAD*
BUILDING DEPARTMENT
P p SEWER
PERMIT - APPLICATION
jP*IOJW 10-66 2^1556***** 126.50
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO.
BLOCK
BUILDINGS
X. ^ £ 4J2? TRAgf ^y^r^,/>'I J-~'> "^
CONTRACTOR
BUILDING
ADDRESS
MAIL
ADDRESS
JO.OO
CITY NO.
CONTRACTOR'S'STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO.DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @
SEPTIC TANK, SEEPAGE PIT OR
PITS @
OVERFLOW SEEPAGE PIT, DRA1NFIEUD
CESSPOOL, DRYWELL, MANHOLE @
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @
S3.0O
*5.00
EXTN.,
$5.OO
SI. SO
$I.5O
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.OO
@ $
OWNER'S PERMIT $
AUTHORIZATION TOTAI_ FEE
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD-
ING TO THE PUBLIC SEWER.
SIGNED THIS
OWNER OR
OWNER'S AGENT .
DAY 6F
ADDRESS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY 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 DESCRIBED RESIDENTIAL PROP-
ERTY.
SIGNATURE
OF PERMITTEE
CITY TEL. NO.
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V.
Add. Horiz.
Add. Vert.
1/5*Total Construction Cost
10% Service Charge // <
Total Lateral Cha
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:
C. C. @
P. S. @ _ / dwelling
OTHER
/ dwelling
Grand Total, Lateral, etc.
FOR SEWER LOCATION
NORTH
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION