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HomeMy WebLinkAbout1313 CHINQUAPIN AVE; ; SE647792; PermitBUILDING DBrilitTMENT 7792 SEWlft PERMIT - APPLICATION FOR APPLICANT TO FILL IN - LEGAL f*dk^*&^**f SDESCRFPTION LOT NO. ff ^_. rT-f Jfayf** BLOCK TRACT/%»rtL^^ — — »— -a**- — <~~77?7 USE OF Ql ^** -. jr / BUILDINGS fBT^&* A , CONTRACTOR /JL--7>*A» ^ ^/^— -X*^ ADDRESS CITY TEL. NO. CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO. NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TOPUBLIC SEWER 0 J3.0O SEPTIC TANK, SEEPAGE PIT OR PITS 0 *8.0O OVERFLOW SEEPAGE PIT. DRAlNFtKLD EXTN.. CESSPOOL. DKYWEt-L, MANHOLK 0 SS.OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 0 S1.SO CONNECT ADDITIONAL BLDG. OR ALTER. REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 0 S2.OO 0 * OWNER'S PERMIT S L AUTHORIZATION TOTAL FKI 2 OO 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD. ING TO THE PUBLIC SEWER. OWNER OR ADDRESS ~- — : — ] 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 R EGO LATINO 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 AtfcJHELEOALOWNER OF THE AB0<ffi DESCRIBED SpSlDENTlKrTPROP- | or rrnMirrrtt^r&iWX f XPt**^— *" -7 j BUILDING . _ - . X ^. — ADDRESS f £/ ~? fitf^rK rfV --'lff i^^-*—^NEAREST L_ / X * A ^'CROSS ST. T/^j^^X^^ ^flj^C- - OWNER ^?f JT. *f99 £& P~ 1—t*<Jp-ff^JL ADDRESS J 3&J l^gLt~-**~e*J&-*J*~** "-' CITY Lateral C 30' H., 10 Add. Ho Add. Ver 10% Serv Ut. No.: TEL\NO. CONNECTION DATA harge Computation 1 v t$ 4" — y — //5"jOu © 4» «- A" — Totfll Onrtnifftion Coit //,5.0^.,, Tnt«i l»tnr^l C1""^- f^4-,vV . -. — . .._ _l-ogged in__Plat: LINE COST DATA A. D. & A«mt_ Nn i INF C:O<;T. C. c. @ P. S. @_ OTHER . 3^ f EN Signed t*~ / ,»W«1Hng f{> 2? _ / Hwnlting TrtTA| „ FOR SEWER LOCATION co St. NORTH G1NEERING SEWER DEPT. _ ___ _ I SinnA^ TMs b a S«wer Permit When Properly Filled Out, Signed and Validated liHMd By PERMIT VALIDATION