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HomeMy WebLinkAbout1200 CHINQUAPIN AVE; ; SE658452; PermitCITY OF CAftUBAD BUILDING DEPARTMENT SEWER PERMIT - APPLICATION Qf W6-5-65 z^FT 89»********5.GO FOR APPLICANT TO FILL IN 1 LEGAL DESCRIPTION LOT NO. BLOCK s~~\ ^TRACT USE OF L } L . BUILDINGS i\^V<.>'Tl — CONTRACTOR /j£^"?ia 1^. 1 ADDRESS I //i, /' / , {W CITY( Yi<. -.-££?£•&: /r 1 CONTRACTOR'S STATE 1 LICENSE NO. ^ >• sf/Sf' 1 's*'l£~i ./ 'Cr-r*x —x ii*-"v?€>-f^; v^ 'i 1 ^TEL. NO. X>;-V i, _....- ij CARLSBAD BUSINESSLICENSE NO. NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 9 $3.OO SEPTIC TANK. SEEPAGE PIT OR PITS & SS.OO OVERFLOW SEEPAGE PIT, DRAINF1ELD EXTN., CESSPOOL, DRYWELL, MANHOLE @ SS.OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $I.BO CONNECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER @ $1 SO ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $a.OO 9 * OWNER'S W AUTHORIZATION 1 HAVE AT THIS DATE A CONTRACTOR TO CONNEC ING TO THE PUBLIC SEW OWNER OR ADDRESS PERMIT $ TOTAL FEE 3 2 C>s'} OO CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD- ER. DAY 6F 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 CALIFORNIA OR" THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP- ERTY. «^-7f"7'Tr} t nSIGNATURE f fa ''Lt^tsl V . . srt, ^ * OF PERMITTEE / '/)*"*~ ff~ Jf*^ BUILDING / -< _ „, /•")/. ; ,--, ' ADDRESS ii^UC'' (.' ft- i"*->-^"t: "Cvi' /---<--£..- NEAREST _/- r*^ / / CROSS ST^ •C.jfil's..';. < ' <O ' OWNER kli^f./'t'^ -i.-<-~-' — -* MAIL S ADDRESS CITY TEL. NO. CONNECTION DATA Lateral Charge Computation 30' H.. 10' V. ® 4" — A" — A JJ HnriT (J5) A." A" Add. Vert. © 4" — _.__ &» — Total Construction Cost . » 10% Service Charge Total L«tHr»l Charrja Lat. No.: _ .. . Logged in Plat: LINE COST DATA A. D. & A«mt. Nn LINF COST- C. C. ® / ^filling P. S. & __ / rlwslnnrj OTHPR TOTAI Grflnrl Total, l.ntftrdl, f^f. FOR SEWER LOCATION St. NORTH ENGINEERING SEWER OEPT. Signer) 1 <;ignRr< This is a Sewer Permit When Properly Filled Out, Signed and Validated Issued By PERMIT VALIDATION