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HomeMy WebLinkAbout155 CHINQUAPIN AVE; ; SE679847; PermitCITY OF (ARLSBAfc BUILDING DEPARTMENT 0994-7 SEWER PERMIT - APPLICATION VK 26-67 5*5? t23*******5.00 FOR APPLICANT TO FILL IN LEGAL DE CR1PT1ON LOT NO BLOCK USE OF BUILDINGS TRACT _ s n CONTRACTOR (JL.^ A— \&J -Z-SL lS~C. (_-C_^ ADDRESS ,-£L!D / V CITY t-'/Q *rf-4. • CONTRACTOR S STATE LICENSE NO NO DESCRIPTION OF *xt4 ULJ TEL NO CARLSBAD BUSINESS LICENSE NO WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 OO SEPTIC TANK SEEPAGE PIT OR PITS @ $5 OO OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 OO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 5O CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ S1 5O A_TtR REPAIR OR ABANDON HOUSE Si: VCR OR DISPOSAL SYSTEM @ $2 OO @ S OWNER S AUTHORIZATION 1 HAVE AT THIS DATE A CONTRACTOR TO CONNEC ING TO THE PUBLIC SEW SIGNED THIS OWNER OR OWNER S AGENT ADDRESS -&. 1 HEREBY ACKNOWLE APPLICATION AND STATE AND AGREE TO COMPLY V\ STATE LAWS REGULATINC 1 HEREBY CERTIFY TH AND/OR LICENSED AS RE BAD AND STATE OF CALIF OWNER OF THE ABOVEERTY s~^ ,A SIGNATURE ( V^ OF PERMITTEE V.yf.r'C* PERMIT $ TOTAL FEE *> 2 %$n 00 OO 00 CONTRACT WITH THE HEREIN T THE ABOVE DESCRIBED BUILD ER PAY "F DGE THAT I HAVE READ THIS THAT THE ABOVE IS CORRECT flTH ALL CITY ORDINANCES AND 3 PLUMBING AND SEWERS AT 1 AM PROPERLY REGISTERED QUIRED BY THE.C.ITY OF CARLS ORNIA QB-*UAXl AM THE LEGAL gBpCyBED RESIDENTIAL PROP £_•*. _^«>Ox5x«r/%^^'— — *•p/r* •*/6f0V*Vr BUILDING y __x,^- /~) / > S^s .ADDRESS /OT5 CJ»>7/vv 4?£4<p /^yt/ NEAREST / CROSS ST OWNER //J&. -ftetsStfr" ADDRESS /?T ? j?$x:*3>$£2-o CITY CrfY/7)&/ TEL NO CONNECTION DATA Lateral Charge Computation 30 H m V (a) 4' — A — A.I.I 1 |...n. (n) 4.' //' — Arlrl Vni-t (0) 4 — A" — Tntfll Cnn*;+ructmn Co$t . ,. 10% Snrvir.fi Chargn Total 1 fltsral Chflrgn Lat No Logged in Plat LINE COST DATA An» A«mt N" LINF COST C C (5) / rlwcllmfj P S <3) / rJwBllmrj OTHFR TOTAI FOR SEWER LOCATION St NORTH ENGINEERING SEWER DEPT Signfiri 1 ^irjnfirl This is a Sewer Permit When Properly Filled Out Signed and Validated Issued By PERMIT VALIDATION