HomeMy WebLinkAbout1250 HOOVER ST; MULIT-PERMIT FILE; CB061553; PermitCity of Carlsbad
' ~ , 1635 Faraday Av Carlsbad, CA 92008
06-02-2006 Plumbing Permit Permit No: CB061553
Job Address:
Permit Type:
Parcel No:
Reference #:
Project Title:
Applicant:
Building Inspection Request Line (760) 602-2725
1250 HOOVER ST CBAD
PLUM
2061501900 Lot#: 0
Construction Type: NEW
MANZANO RES-REPLACE WTR HTR
Owner:
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
ISSUED
05/31/2006
LSM
05/31/2006
05/31/2006
ALL STAR WATER HEATERS & PLUMBING MANZANO ALLEN J&BARBARA C INTER VIVOS TRUST 03-2
17886 LAKESHORE DR 92530
1-800-727-0977
Plumbing Issue Fee
Fixture or Trap
Building Sewer
Roof Drain
Install/Repair Water Line
Water Heater and/or Vent
Gas Piping System
Vacuum Breaker
Other Plumbing Fees
Master Drainage Fee
Sewer Fee
Additional Fees
TOTAL PERMIT FEES
Total Fees:
Inspector:
$27.00
0
0
0
0
1
0
0
1250 HOOVER ST
CARLSBAD CA 92008
$20.00
$0.00
$0.00
$0.00
$0.00
$7.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$27.00
Total Payments To Date: $27.00 Balance Due:
VAL
b i Clearance:
$0.00
NOTICE: Please take NOTICE th t approval of your project includes the 'Imposition' of fees, dedications, reservations, or other exactions hereafter collectively
referred to as "fees/exactions.' You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Ca~sbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
., FOR OFFICE USE ONLY
PERMIT APPLICATION
PLAN CHECK NO Qfi)015~3
EST VAL
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad CA 92008
Plan Ck Depo:,.t ~"' -"
Validated By ___ <L_~ 1V
Date es') .3 I / Oh
1.~,...t,.\O.,!£
1250 HOOVER STREET,
Businoss Name (at this lddr81s)
legal Ce1c11puon Lot No, Subdlv!1l011 Name/Number UnitNo. Pnase No.
EJcisting Us♦ Proposod U..,
Ottet1pwn of Wo~ -
WATER HEATER REPLACEMENT
SQ.FT. U vf 041 ' (,-,-, -
2. . CONT ~CT el:R~QN. (it dJffoNnt~ -760-434-1667 _--A.LLHJ..~ZANO 1250 HOOVER STREET, CARLSBAD, CA 92009
II lime Address City Slate/Zip
3, APP~ICANJ_ ~~~ntlpfCoolr&ctpr
------·~-....
Name --Telephon1;1 ~
Nijmti Addten C,ty State/ZIP Totephone .-----
~~~ • Q'1f4'6NX tf4N~"tftittJ,:il lufUi 'ti {el?:& · iW~'itrrit¥,ao, c,· , c · '..cw .... ~.i.t. • >
(Soc. 7031.S !lua1nau 1111d ProlenJons Co<te: Ally City 0, Coun1y which tequlttlt • permit to conat/uc~ atler, lmprol.'O, demolish or repu dny •tn,c:uru. Pl ~ ·•
also require& the app11ea111 fOf auch pennlt to f~• • tlgned ,uitement that he 11 llcenaed p11rauant to the provialons of lhe Controctor, licen,e La,i [~nap•• ~ _
Section 7000 ol O¼ion 3 o( !he BialflOsa end Professions Code) or that he II exempt 1110,.trom, and the basia for !he :illeged o,empt,c.,• An~ v, ·t.it, , ~• , ·A~r'srA~0wATI1ftH1TrrRsppf,~l lO Mtoo'P~E'Rrb'\?A°Lt~~lW~ doll~~~flb'EE CA 92584 800-727-0977
Name f\OdresS City -· State(llp --lc,,:..,nc.' -· ~
State License u .Bl 2894 License Class___ C36 C1ly OuslC)ess Lic~n:-,,., 11 _ I~ d I 4 I t
Designer Name Address State/Zip
S:ate ucense 11 _______ _
, .• _J!O,l\~~-~.9,.Mf,W!Wl,0,.ff .... .,, •· . •
: 1ork&r&' Comp¢nsa11011 01tclaraU0n· I horQby alfltrn under penQl\y of perjury on& or tho fohowlnu doclarations:
C I nav4 an<S Wltl maintain a C'ellJIICllto of consent to aelt•ln,ure for workera· comp4nsatlon as provcdOd by Socuot1 :HCO vi tho Labor Co,;~. 10, u .. , r• , r
fer wh.ch 1n,1 p;,,m,I ii ,nued
/' 1 nav• ano wol ma,01.11111 wor~er's compen$aUon, as required by S11ctJon 3700 of the labor Codo. lor 1110 p.-,turni..mc~ c.1 U•d v,utt. :c,, ,vc ,. ,. ,
...otk~f• comPl)nlabon '"'"'•E'1:005 and P()licy n~tnber aro: 1761641 o4 . 9/2006 1";.ira,u Company _ST ATE ______ PolJcy No,,________ _ E~prr~~o,, D.,t.:
tTHIS SECTION NEED NOT SE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100} OR LESS)
CERTIFICATE OF EXEMPTION: I ce<llfy Iha! rn the porformonce of lne worK fOf which lhil permit ,s IUut,d I >lra•I ""' ~n:vlu, "., l''-'•-
~1,come la0,cc1 to 1)1.; Workers' Compon tion Law& of Cuh/omla.
\',ARNING: f■llur• 10 ucur• workers' peJ\I
d01l•r~StOO,OOO), In addlUun 10 lht CO& cl CO
SIGNATURE
'I ,i.;,,,J!!J.H , ~
I hereby alfirm I/lat I am
□ I, os owner ol lhe property or my employees wilil wagu as their aole oornponsaUOn, wll d lhe w011( and the atructut1, 1, not in1cnded or of!e«, f.,, ,J <' ,o
au,;nen and Profenion• Colle. Tho Cootra<:10r'a Licena. L,aw d011$ not lll)ply to an owner of property who builds or improves thOreon. and wr,o does ,,,_h "'"''· ~ •. · •-
mrouuh hi$ own emptoyeea, provided that lllCh improvemeot1 11111 not Intended or ottered !Of N.18, If, Mwever, the building or ,mp,ovemeo1 ,. • .,, :-.·,tt, ~
et:mpletion, lhu owner-bu,lder lllill have lhe burden ot proving that he did not budd or impro1111 ror tho p,Jrpoao of aale)
□ 1. a, ov.Mr of lh• property am exclusively contracting w,lh llc'1nsecl contractors lo consll\lc:t the pro)OC! (Soc. 7044, bus nes& "nd Protns· .. 01,s c ... ~c ; • _ v'-
l.::ensc Law con nol apply 10 •n awner Of proper1y wl\o bullda 01 lmpiove, lhoreon, and contracts for sveh projects with contractor{s) l,:<>r.sc~ ;,uti-,,~, 1 t< ..
L1Ctn$d LU'll)
C I am e,empt un~er Socllon ________ eualne.a and Proleu!011s Code for 11\1& reason.
t pe,sona ly 1)13n tc proor.oo lhe ma;or labc( and n1a1erials lor conatruct,on of Ille proposed properly unprovem~111 O Y~ S u N()
• 1 1na,elhave not) &>i)neu an appllca~011 ror a buidU\Q perm,t fo; tna propoaod wonc.
r ~a,v ~ntracted will\ the lo41w.-,119 person (fum) to provide the propoae<i construe1>on (mduoe nomo I addrcs, I i,none numb~r 1 = :, . .,.,c'• "'~''' , _,
4. 1 p1a11 to PfOVlde por1loN 0/ ll'I• work, but 11\avo hlted lite totlaw,ng person lo ccotdlnate, sc,pen,1511 and pi,,-,ao th~ ma,c,, ..-,{,« 111,cluv• ""'" r a~. ••
lonl/ac:tofl litense number): ------------------.,.---------___ . ,. __ s, 1 WJII PIOvidt Dorne of !he w011\, but I have contracted (hired) the following persona lo provide U10 work mthcat1,a (111cM1e numv I ~uu,v\\ "'""'" """ -
PRCPEI, TY OWNER SIG,-,.ATURE _____________ _ 01\TE
WHITE: File YELLOW Apphcant PINK· F1ni111c.:
·9-City of Carlsbad Bldg Inspection Request
~ For: 08/16/2006
Permit# CB061553 Inspector Assignment:
Title: MANZANO RES-REPLACE WTR HTR
Description:
Type: PLUM Sub Type:
Job Address:
Suite:
Location:
1250 HOOVER ST
Lot 0
APPLICANT ALL STAR WATER HEATERS & PLUMBING
Inspector:
Owner: MANZANO ALLEN J&BARBARA C INTER VIVOS TRUST 03-2
Remarks: am please _please
~
----
Total Time: Requested By: HOMEOWNER
CD
25
Date
-
D_e_s_c-rip-t-io_n _______ ~Comme§t.ered ny
Water HeaterNents P'f-~ p'\'._
CHRISTINE
---------------------------------
Comments/Notices/Hold
Associated PCRs/CVs Original PC#
Inspection History
Description Act lnsp Comments
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
10-30-2002 Plumbing Permit Permit No: CB023316
Job Address:
Permit Type:
Parcel No:
Reference #:
Building Inspection Request Line (760) 602-2725
1250 HOOVER ST CBAD
PLUM
2061501900 Lot#: 0
Construction Type: NEW
MANZANO RES-REPLACE H2O HEATER
Status: ISSUED
Applied: 10/30/2002
Entered By: RMA
Plan Approved: 10/30/2002
Issued: 10/30/2002
Project Title: Inspect Area:
013110/30/02 0002 01
CGP
Applicant:
A&J FOSTER, INC.
STE B
13706 HWY 8 BUS
EL CAJON CA 92021
619-390-4477
Total Fees:
Plumbing Issue Fee
Fixture or Trap
Building Sewer
Roof Drain
$27.00
Install/Repair Water Line
Water Heater and/or Vent
Gas Piping System
Vacuum Breaker
Other Plumbing Fees
Master Drainage Fee
Sewer Fee
Additional Fees
TOT AL PERMIT FEES
Inspector:
Owner:
MANZANO ALLEN J&BARBARA C INTER VIVOS TRUST 03-2
1250 HOOVER ST
CARLSBAD CA 92008
Total Payments To Date: $0.00
0
0
0
0
1
0
0
FINAL APP OVAL
Date: l I rV
Balance Due:
Clearance:
$20.00
$0.00
$0.00
$0.00
$0.00
$7.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$27.00
$27.00
NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
referred to as ·tees/exactions.• You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. II you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
v r vi I . N . hi h f limi i I h
02
27-00
FOR OFFICE USE O~~
PLAN CHECK No (l/J() l_J f / ,6 rERM~T APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
EST. VAL. _________ _
Plan Ck. Deposit '797r-
Validate/d A : mi£
Date _(,L.1Zl tlr::[;i-
~1;~]iilm,.e~rt1NRO.flMA.T,iQ,N[ili:1,-;,;~m1iw:1:~,11,ctf\VI~tj:,i'~~iri~r~m~Ii~!m'r.itiiY~ri!i1J.l~W:lffli~il~rl~ti
1250 Hoover St
Address (include Bldg/Suite #I Business Name (at this address)
Legal Description Lot No. Subdivision Name/Number
SFR
Unit No. Phase No.
Assessor's Parcel # Existing Use Proposed Use
Total # of units
206 150 19 00
Description of Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms
,.;'""''''c· b7~t~~,.,~!!-~~t,f-1,if;;,,};fr":eJ2nd;i,z~#J~Pctn'"t·,i,rq:~!,l',•••~~,:;,;~~ilqf,~lllih'¥ll"'-"'?'l<',"'ri{ffft~fil'l>!l'R:i,;1';ftl'~!i!~~i!l!i'.11'~i;r~~lfl1'JIR>'l!m:!1"!!!:);'!l:i~;~ii•;ts<®"'lt;TT,,:-::·i l~I,iY.•'L~i;ii"~ri~~t·' , ... Jlm~1!!ilMlf':t50[,\"'ir~~~f.,11,;sf•~li,!,,Y,.,ti~(ilil••tar lsnad~~-"""tl':'"""''g·Jo'o'S':.ml!'s7i5·0~4:.y4::.·r·()'o7'dJ•"•"""i•
Name Address City State/Zip Telephone # Fax #
@:~i~~~e~~~~~,~~~rt;~~~~~1~f1~~~g,~:~~if-~~'?~~i1~$~~~~~!°1~t-ff~tf"~~i~!~~~~1~1~~
Name Address City State/Zip Telephone # t~)!\;t;;~~~~~~~~~~r~~']'imf,~!~~i~]/,/~~iri~]fiT~i~!;~~i!:;;~~:~-~~~i:2:r;:~~~l~~-~6~i,m1$]J~~~fil!~T~f-g~~~~~i~~l~l~:\l~
Name Address City · S,tate/Zip Telephone #
l1i'illu:\i,~QNirRi.K¢.'ltOBm.c.o.MtfANY!,NA~1~1i:~,rlll~~f,i'l,~{J'~,~J'.'il~-~&-~"!r~~~-~~fr,lmSf,;~:[&;"'1P;!i,~~
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its
issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of no.t more than five hundred dollars ($500]).
rf, & J Foster Plumbing ame
13706 B Hwy 8 Bus E] Cato CA 9202) /6)9)390 4477 Address ity State/Zip Telephone #
State License # __.6..,J.,...Q._.J~2 ... Q..,_ ___ _ License Class C-36 City Business License# 1210836
Designer Name Address City State/Zip Telephone
State License # N (A .
i~Im'.i!llW§"JJKE!IS~C¢9'.M~t"N..tiitIP'.it'!i~!;i"i."l!iID~l{!~'jtit1~4iki1~:~:f,~~~:;,~~1f1tt?it',t~;;;f~~~~1.l.1~~17a.,._'im!J~~~~~~~~1ii'~f.4~~~~,i~Jt~!.f;,ffi~,\¥l'i\~~t~1!;'~
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
IJ I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
1/;sued. My worker's eompensation insurance carrier and policy number are:
Insurance Company Stat~ Comp, Ins, Policy No. 467 Q] QQQQ7) 3 Expiration Date 04-01-03
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS)
D CERTIFICATE OF EXEMPTION: I certify. that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as
to become subject to the Workers' Compensation Laws of California.
WARNING: Failure to secure w Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars ($.;100,00 , damages as provided for In Section 3706 of the Labor code, Interest and attorney's fees.
SIGNATURE . DATE _________ _
O I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not Intended or offered for sale
(Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does
such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner-builder will have the burden of proving that he did not build or Improve for the purpose of sale).
D I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed
pursuant to the Contractor's License Law).
D I am exempt under Section ______ Business and Professions Code for this reason:
1. I personally plan to provide the mafor labor and materials for construction of the proposed property improvement. D YES ONO
2. I (have I have not) signed an application for a building permit for the proposed work;
3. I have contracted ,with the following person (firm) to provide the proposed construction (include name I address / phone number I contractors license number):
4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number): ______________________________________________ _
5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address / phone number I type of workl:, ________________________________________________________ _
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management a.nd prevention
program under Sections 26505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? D YES O NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES D NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES D NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
i!i1if.wSt9~.ij.$[8l:IQ]i_C:lN1~eff PIN~~~~NC.:-Yi1ffiffi~~J~I'ii{~~~J~~~~~--tfu1!1i',~iit]i.\)1[ff~];mS~ilf~!i'.tii~~"'lftfl~]~llrn,i{~]fuf,t!£;1'~f1::t~~~\ii~i:ltift
I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER'S NAME f>OblE LENDER'S ADDRESS. _______________________ _
t~\Jt:r&AiiffilfCwf ![e'BTjf,(Q]f'"(@ffl'mm·T~f;mJ~l~!tl!i:'li:1.i/[~:i'~~it.::ilmmi~J'J,;i"r;~~:~l~.,,~~~~-f~~~~~Jiif~~~~,fli'idPiiltl'~~\'r.J.1.l:i
I certify that I have read the application and state that the above information is correct and that the Information on the plans is accurate. I agree to comply with all
City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit\' of Carlsbad to enter upon the above mentioned
property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES,
JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the building Official under the prqvis' s of this Code shall expire by llmltatlon and become null and void if the building or work
authorized by such permit Is not com~en t 80 d~~ the d f su permit or If the building or work authorized by such permit Is suspended or abandoned
at any time after the work Is comme I o 11' j'i.s, · nlform Building Code).
APPLICANT'S SIGNATURE __________ ...,,_____________ DATE (0 r 'SO
WHIT : File YELLOW: Applicant PINK: Finance
City of Carlsbad Bldg Inspection Request
For: 11/13/2002
Permit# CB023316
Title: MANZANO RES-REPLACE H2O HEATER
Description:
Type:PLUM Sub Type:
Job Address: 1250 HOOVER ST
Suite: Lot 0
Location:
APPLICANT A&J FOSTER, INC.
Inspector Assignment:
Phone:
Inspector: _f \J\f"'
Owner: MANZANO ALLEN J&BARBARA C INTER VIVOS TRUST 03-2
Remarks:
Total Time: Requested By:
Entered By: KAREN
CD Description
25 Water HeaterNents
b_ Comments
Associated PCRs/CVs
Inspection History
Date Description Act lnsp Comments
CITY OF CARL~BAf SEWER
BUILDING DEPARTMENT PERMIT. APPLICATION
FOR APPLICANT TO FILL IN _J. ____ _
LEGAL
DESCRIPTION
BLOCK
LOT NO
TRACT ---------USE OF
BUILDINGS
CONTRACT_O"---'--'R ____ _
ADDRESS
C ITY TEL. NO.
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEW ER CONNECTING TO
PUBLIC SEW ER ~00
SEPTIC TANK, SEEPAGE PIT OR
P ITS__________ @ $5.00
OVERFLOW SCEPAGE PIT, DRAINFIELO EXTN,.
CESSPOOL, ORYWELL, MANHOLE @ $5.00
HOUSE SEW ER CONN ECTi'N'G TO -----
PRIVATE DISPOSAL SYSTEM @ $1.50
CONN ECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER __ @_$1.50
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ 52.00
OWNER'S
AUTHORIZATION
@ $
I
PERMIT
TOTAL FEE
s 2 00
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD-
ING TO THE PUBLIC SEWER.
SIGNED THIS-----DAY OF ----------
OWNER OR
OWNER'S AGENT
ADDRESS ---
---1 -HEREBY ACl<NOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY W ITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS.
I H EREBY 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 PERM ITTEE
BUILDING
ADDRESS
NEAREST
CROSS ST.
OWNER
MAIL
AODRESS
CITY T EL. NO.
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V.
Add. Horiz.
Add. Vert.
@ 4" --
([i 4" --
(al 4" = -
--6" = ---------
10% Service Chorge
I a'. No.:
-6,, = ---------
-6" = ---------
Total Construction Cost ____ _
Total Lateral Chorge
Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:_
C. C. @• ___ / dwelling ______________ _
P. S. liJ' ___ / dwelling
OTIIER _
...: V)
TOTAL
Grand Tota l, Lateral. etc.
FOR SEWER LOCATION
St.
...: V)
ENG INEER ING SEWER DEPT.
Signed _ I Signed
NORTH
This is a Sewer Permit When Properly Filled Out, Signed and Validated
Issued By __ _
PERMIT VALIDATION