HomeMy WebLinkAbout241 Olive Ave; ; SE680131; PermitCITY OF CARLSBAD SEWER /65
BUILDING DEPARTMENT PERMIT· APPLICATION
~/?-I 3/ .-----------------------
LEGAL DESCRIPTION
BLOCK
USE OF
BUILDINGS
FOR APPLICANT TO FILL IN
LOT NO.
C
CONTRACTOR O ~
ADDRESS
CITY TEL. NO.
-
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER • $3.00 '1'
SEPTIC TANK, SEEPAGE PIT OR
PITS 0 $15.00
OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,
CESSPOOL, DRVWELL, MANHOLE • $15.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM • $1.150
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER • S 1.150
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 0 $2.00
• s
OWNER'S PERMIT s 2 00
AUTHORIZATION I TOTAL P'IEIE ,5'0 tt
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 OF ----------
OWNER OR
OWNER'S AGENT-----------------
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND
STATE LAWS REGULATING PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR L ICENSED AS REQUIRED BY THE CITY OF CARLS-
BAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOV. DES IBED RESIDENTIAL PROP.
ERTY. SIGNATURE
BUILDING
ADDRESS
NEAREST
CROSS ST.
OWNER
MAIL
ADDRESS
CITY TEL. NO.
CONNECTION DATA
Loteral Charge Computation
30' H., 10' V. @ 4H = ___ 6" = ---
Add. Horiz. @ 4" = ___ 6" = ---
Add. Vert. @ 4" ---6" = ---
Total Construction Cost
10% Service Charge
Total Lateral Charge ____ _
Lat. No.: Logged in Plot:
LINE COST DATA
A. D. & Assmt. No. _______________ _
LINE COST: -~---------------,~ _-rP_ ~ ao /c. C. @~dwelling ,?':::'1:-
P. S.@
~t)O
~1-----------------1~
NORTH
SEWER DEPT.
Signed Signed ________ _
OF PERMITTEE )(_'------~"""-----t------1---------1
This is o Sewer Permit When Properly Filled Out, Signed ond Volidoted
luued By------------------
PERMll VALIDATION
5.00