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HomeMy WebLinkAbout1251 KNOWLES AVE; ; SW691803; PermitCITY OF CARllBAD BUILDING DEPARTMENT FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. BLOCK TRACT USE OF BUILDINGS CONTRACTOR ADDRESS C ITY TEL. NO. CONTRACTOR"S STATE LICENSE NO. CARLSBAD BUSINESS LICENSE NO. NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ S3.00 ... ------..,-SEPTIC TANK. SEEPAGE PIT OR PITS @ $5.00 OVERFLOW SEEPAGE PIT, DRAINFIELO EXTN., CESSPOOL, ORYWELL, MANHOLE @ $5.00 HOUSE SEWER CONNECTING TO PRIVATE D ISPOSAL SYSTEM @ S1.50 CON NECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER @ S 1.50 ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2.00 @ s OWNER'S I PERMIT s 2 AUTHORIZATION TOTAL FEE -- -- -- -- - 00 I H AVE AT THIS DATE A CONTRACT W ITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD· ING TO THE PUBLIC SEWER. SIGNED THIS -----DAY OF ----'--------..--OWNER OR OWNER'S AGENT ----------------- ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL ICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY W ITH 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 SEWER PERMIT -APPLICATION DUILDING ADDRESS NEAREST CROSS ST. OWNER MAIL ADDRESS CITY Jc,L Z.Z -r,, J -:fl / ~ o 3 T EL. NO. CONNECTION DATA Lateral Charge Computation 30' H., 10' V. @ 4" = ---6" ---- Add. Horiz. @ 4" = ___ 6" ---- Add. Vert. @ 4" = ___ 6" ---- Total Construction Cost 10% Service Charge Total Lateral Charge ____ _ Lot. No.: Logged in Plot: LINE COST DATA A. D. & Assmt. No. ________________ _ LINE COST: _______________ _ C. C. @ __ / dwelling ____________ _ P. S. @ __ / dwelling _____________ _ OTHER TOTAL Gra nd Total, Lateral, etc. FOR SEWER LOCATION ~-----------------1~ St. ENGINEERING SEWER DEPT. NORTH Signed ________ _ This is • Sewer Permit When Properly Filled Out, Signed end Validated Issued By ----------------,------ PERMIT VALIDATION