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CSD 1986-40407COUNTY i✓U woe /l ' OF SAN DIEGO * RESIDENTIAL WASTEWATER DISCHARGE PERMIT APPLICANT FILL IN— PLEASE PRINT LEGIBLY )WINE R' � O BY CASHIER ME �--4 PLUMBING PERMIT NO. ICING • t Ins • THIS PERMIT VALID UPON RECEIPT OF PERMIT FEES IDORESS ILL, tr t T DISTRICT 3 4j5_ trp.!5 C� � Santabonricl � 'Ti��ii pest FUND NO. IC'tYl Zip ASSESSORS PARCEL NO. PHONE PROPERTY OWNER AGREES TO PAY CONSTRUCTION COSTS EXCEEDING THE CALCULATED FEES AND OTHER ADDITIONAL FEES LEVIED AS A PART OF THIS PERMIT THE OWNER AGREES TO PAY ALL SEWER SERVICE AND OTHER LAWFUL CHARGES REQUIRED BY ORDINANCES OWNER IS RESPONSIBLE TO ESTABLISH LOCATION OF LATERAL AND DEPTH AT PROPERTY LINE Initial OWNER UNDERSTANDS THIS PERMIT BECOMES VOID IF WORK IS NOT COMMENCED WITHIN 180 DAYS AFTER PERMIT VALIDATION OR IF WORK HAS BEEN SUSPENDED FOR A PERIOD OF 180 DAYS. Initial 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND THE LIST OF PROHIB17 ED SUBSTANCES ON THE BACK THE INFORMATION I HAVE PROVIDED IS CORRECT THE OWNER AGREES TO COMPLY WITH ALL SANITATION DISTRICT ORDINANCES AND STATE AND FEDERAL LAWS REGULATING SEWERS I ntrel TOTAL ANNUAL SEWER SERVICE CHARGES THIS S PARCEL (/Q�'� DPW FIII In SEWER LINE\% STREET SEGMENT WIDTH LATERAL LOCATION SEWER m Mo. Ds. Yr. DEPTH ❑ EXTRA WIDTH FEET EXTRA DEPTH FEET Fmul InspeLi Date PREVIOUS EDU[ EDU THIS PERMIT TOTAL EDU ON PARCEL SIGNATURE OF DPW FIII In TOTAL CONSTRUCTION FEES PERMITTEE S Property _ Owner ❑ Plumber . L]Ownar'a ❑Contractor PHONE DATE TOTAL CAPACITY FEES Agent 5 DPLU FILL IN SEWER CONNECTION © STREET ❑EASEMENT C3 EXISTING O ❑ REIMBURSEMENT AGREEMENT NO m_m REQUESTED: ❑ALLEY 061N LATERAL LATERAL ❑TRUNK LINE /PUMP PARCEL STATUS: ❑ COUNTY INSTALL ❑CONTRACTOR INSTALL TOTAL MISC. FEES V L OCCUPIED LOT $ - []New Buddmq Existing Bldg, on Sept¢ []Change in use Move On Addtmn ITo Bldg.) ❑ Demolish and Rebudd FEES & EDU VERIFIED: Mo. /� PARCEL WER NUW j��7 (`5/ SEYES NO �� Q�( ��(/�I /Q�7� DEPT. OF PUBLIC WORKS WER BOOK PARCEL NO. ®LY�JLJLJ 5555 OVERLAND AVE. FE ES VALIDF R6DDAY THOMAS �1��:/� SAN DIEGO, CA 92123 OR UNTIL ADDITIONAL INFO: BROS'MAP I�I..CI 565 -5332 ate LEGAL DESCRIPTION ❑GRANT DEED -DOC SIGNATURE LOT SPLIT ❑CERTIFICATE OF COMPLIANCE PARCEL MAP DPW FIII in ❑ SUBDIVISION NAME BOUNDARY ADJUSTMENT ANNUAL SEWER C E] OTHER f - SERVICE CHARGES MAP NO. BLK LOTS THIS PERMIT ONLY SITS / f DPLU FILL IN ADORES S t %%Z /✓1 � JC%(/� PRORATA PORTION SEWER SERVICE CHARGES TYPE OCCUPANCY i T : FOR BALANCE OF TAX YEARS) LJ Single Family Dwelling Apartments /Duplexes II TOTAL SEWER SERVICE CHARGES THIS PERMIT ❑ Condominums FH Mobile Homes 4 Br. 3 Br. m Z gr, m f Number of Contlo. or Mpb. Br. DPLU FILL IN T TAL PERMIT FEES IA,BtC'0 - E.h DPLU ADDRESS- S ❑ WORKSHEET ATTACHED ❑Other 'LU FILL IN PLAN CHECK NO T-��( DPW FIII in O m _ ORIGINAL PERMIT THIS PERMIT SIGNATURE DATE O 5201 Ruffin Rd. 334 Via Vera Cruz Sao Diego, CA 92123 1:3 San Memos, AA 92069 CALL 565 5657 FOR LATERAL CONSTRUCTION 565 -5920 741.4236 RESIDENTIAL PERMIT