HomeMy WebLinkAbout1708 BONITA LN; ; SE658728; Permit(JTyw-AD
BUILDING DEPARTMENT PERMIT - APPLICATION
PA10 OCT -1-65 ?r 261*******5.OO
FOR APPLICANT TO FILL IN
I LEGAL DESCRIPTION LOT NO.
CONTRACTORS STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
-I- -
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OWNER'S - AUTHORIZATION TOTAL FEE
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 6F OWNER OR OWNERS AGENT
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
ERTY. SIGNATURE OF PERMITTEE
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. 8 4" = - 6" = -
Add. Horiz. @ 4" = - 6" = -
Add. Vert. @ 4" = __ 6" = -
Total Construction Cost
10% Service Charge
Total Lateral Charge
Lat. No.: Logged in Plat:
LINE COST DATA
A. 0. & Assrnt. No.
LINE COST:
C. C. @- / dwelling
P. S. Cia- / dwelling
OTHER
TOTAL
Grand Total, Lateral. etc.
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FOR SEWER LOCATION
st. NORTH
ENGINEERING SEWER DEPT.
Signed 1 Signed
/ This i&Sewer Properly Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION