HomeMy WebLinkAbout2671 STATE ST | 2677 STATE ST; ; SE690293; PermitCITY OF CARLSBAD
BUILDING DEPARTMENT
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION LOT NO
BLOCK TRACT
USE OF
BUILDINGS
CONTRACTOR
ADDRESS
C ITY TEL. NO.
CONTRACTOR"S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR
PITS @ $!5.0 0
0\/~RFLOW S~EPAGE PlT, DRAINFIELD EXTN .•
CESSPOOL. DRYW £LL, MANHOLE @ $!5.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.!50
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @ S 1.!50
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.00
@ s
OWNER'S I PERMIT s 2
AUTHORIZATION TOTAL FEE
--
00
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT TH E ABOVE DESCRIBED BUILD-
ING TO THE PUBLIC SEWER.
SIGNED TH IS -----DAY OF ----------
OWNER OR
OWNER"S AGENT -----------------
ADDRESS
I HEREBY ACl<NOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT TH E ABOVE I S 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 LICENSED AS REQUIRED BY THE CITY OF CARLS-
BAD A ND STATE OF CALIFORNIA OR TH AT I AM T HE L EGA L
OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PRO P.
ERTY. S IGNATURE
OF PERMITTEE -----------------
SEWER
PERMIT • APPLICATION
BUILDING
ADDRESS
NEAREST
CROSS ST.
OWNER
MAIL
ADDRESS
C ITY T EL. NO.
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V. @ 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. D. & Assmt. No. -------------=---'----
LINE COST: _______________ _
C. C. @ ___ I dwelling ____________ _
P. S. @ __ / dwelling _____________ _
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
~-----------------1~
St.
ENGINEERING SEWER DEPT.
NORTH
Signed ~-...,...c.....w....-~--Signed ________ _
This is e Sewer Permit When Properly Filled Out, Signed end Validated
Issued By ____________________ _
PERMIT VALIDATION