HomeMy WebLinkAbout1298 BUENA VISTA WAY; ; SE658457; Permitf
BUM)"r(G DEPARTMENT PERMIT - APPLICATION
---- _- DESCRIPTION LOT NO.
BLOCK n R TRACT
US€ OF BU I Lot N68
FOR APPLICANT TO FILL IN I
CONTRACTOR
ADDRESS
CIM TEL. NO.
CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
e$
OWNER'S 1 PERMIT
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 &F OWNER OR OWNERS AGENT
ADDRESS
CONNECTION DATA Laferal Charge Computation
30' H., IO' V. @ 4" = - 6" = -
Add. Hark @ 4" = ___ = -
Add. Vert. 62 4" = - 6" = -
10% Service Charge
LINE COST DATA
A. D. & Assmt. No. d
P. 5. @- / dwelling
this 5 a Sower Permit When Properly tilled Out, Signed and Validated
Issued By
PERMIT VALfDATlON