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HomeMy WebLinkAbout1197 CHESTNUT AVE; ; SE668883; PermitCITY OF CARLSBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. BLOCK .^-j TRACT / JW 19-66 r cc ifjiv»-«"""" y BUILDING 1 1 &] ~~7 /^/7 , / / ADDRESS // / / C- W *?>T~/L7L> i~ NEAREST // ICROSS ST. X7rv;3/-*-j / USE OF //_-/ ~ / BUILDINGS I/ J\ S" )/S~/ jfi C"-e" CONTRACTOR /J- ^ (•*< -£S>S£ ./ G h ^4~ 1 \ C? K) 1 ^} SCI h ADDRESS Q f"^/ 'J /T .)7~e3~7 CT .5^- CITY Qanlx&av TEL- N0- ~72<9-2 J//f" CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO. NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.OO SEPTIC TANK. SEEPAGE PIT OR PITS @ S5.OO OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN., CESSPOOL. DRYWELL, MANHOLE @ $5.OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1. SO CONNECT ADDITIONAL BLDG. ORWORK TO HOUSE SEWER @ $1.30 ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2.OO @ $ OWNER'S PERMIT $ AUTHORIZATION TOTAL FEE *3 o& Z CX) 6~*° 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- ING TO THE PUBLIC SEWER. SIGNFD THIS DAY OF OWNER OR OWNFR'S AGENT ADDRESS — — • 1 HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS- BAD AND STATE OF CALAFe»rf3lA--pR THAT 1 AM THE LEGAL OWNER OF THE ABOVE BCSCRIBED RESIDENTIAL PROP- ERTY ^-*^ ^^ ^^ _--i SIGNATURE <^^/ ^-, ^-—7 ^—^/OF PEKMITI LE^— a<2_ — <f ~^-rr*~^4' — OWNER —7- " i/i/-, H. s MAIL ' ADDRESS CITY Lateral C 30' H., 10 Add. Ho Add. Ver 10% Serv Lat. No.: TEL. NO. CONNECTION DATA harge Computation 1 V. (?) 4" — A" — PIT f?7) 4." — A" L © 4" — A" — Total Construction Cost , ica Chargn Total 1 »Wnl Chargn . Logged in Plat: LINE COST DATA A. D. & Assmt. Nn LINE COST: __ C. C. ® P. S. @ OTHER _ VI EN Signed / Tallinn / rlwellmrj TOTAI FOR SEWER LOCATION St. NORTH GINEERING SEWER DEPT. I ^naA ' / This is a Sewer Pejarfff When Properly Filled Out, Signed and Validated IssilBrl By . PERMIT VALIDATION