HomeMy WebLinkAbout1273 CHINQUAPIN AVE; ; SE710685; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT
SEWER
PERMIT - APPLICATION
FOR APPLICANT TO FILL IN |
DESCRIPTION LOT NO £&>£? /tyC/J^ C,*4A/£}'S
BLOCK TRACT i?VL-
USE OF j-yBUILDINGS <T<£Ty £•*<=. «fx / °?C,
CONTRACTOR
ADDRESS
CITY
CONTRACTOR S STATELICENSE NO
TEL NO
CARLSBAD BUSINESS
LICENSE NO
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOPUBLIC SEWER @ ,$3 OO
SEPTIC TANK SEEPAGE PIT ORPITS 9 $500
OVERFLOW SEEPAGE PIT DRAINFIELD EXTN
CESSPOOL DRYWELL MANHOLE @ $5 OO
HOUSE SEWER CONNECTING TOPRIVATE DISPOSAL SYSTEM @ $1 BO
CONNECT ADDITIONAL BLDG ORWORK TO HOUSE SEWER @ $1 5O
ALTER REPAIR OR ABANDON HOUSESEWER OR DISPOSAL SYSTEM @ $2 OO
OWNER'S
AUTHORIZATION
1 HAVE AT THIS DATE ACONTRACTOR TO CONNECING TO THE PUBLIC SEW
SIGNED THIS
OWNER OR
ADDRESS . —
I HEREBY ACKNOWLE
APPLICATION AND STATEAND AGREE TO COMPLY VSTATE LAWS REGULATINt1 HEREBY CERTIFY TH
AND/OR LICENSED AS REBAD AND STATE OF CALIF
OWNER OF THE ABOVEERTYSIGNATURE
9 $
PERMIT 9 ?• OO
TOTAL FEE
CONTRACT WITH THE HEREINT THE ABOVE DESCRIBED BUILD
ER
DAY OF
DGE THAT 1 HAVE READ THISTHAT THE ABOVE IS CORRECT
/ITH ALL CITY ORDINANCES AND3 PLUMBING AND SEWERSAT 1 AM PROPERLY REGISTERED
QUIRED BY THE CITY OF CARLSORNIA OR THAT I AM THE LEGALDESCRIBED RESIDENTIAL PROP-
A!DDLRDEsNsG'/^3 ^S/HUQjA&tS
CROsfSST >V^<S/^4A/<£/
OWNER *-» » S*yt ./fcrV /" /"" C?X^,
MAIL *" >. jL-f^T
ADDRESS **..i.*|/"»Cl
CITY TEL NO
CONNECTION DATA
Lateral Charge Computation
30 H 10 V <3> 4" ==/. A" — /SO'OO
AAJ Wrt 1 'to jfe'OO k>, _ <B&C
Total Constriirtl^P C~-r?*b **~C** '^**\,>
10% Service Charge $ £<- * ^'
Total 1 atnra| CharqB ^* '"^7 ,,, S1
Lat No Logged in Plat
LINE COST DATA
A D » Assmt Nr, <*-^^O'
1 INE CQST Jf
P S ® / rlwalling
DTHFR „
GrarvJ Total lateral atr "^* "* * 'O
FOR SEWER LOCATION
//" ^ St / NORTH
fNSLNEERW^, / SEWER DEPT
Signed _S^T... ^^^^ ' 1 ^'OnflH
This is a Sewer Permit When Properly Filled Out Signed and Validated
Issued By
PERMIT VALIDATION