Loading...
CSD 1986-40145ir����.� COUNTY �- 1�r�i OF SAN DIEGO RESIDENTIAL WASTEWATER DISCHARGE PERMIT APPLICANT FILL IN- ,ME ILI ity PHONE i s.Ajd4 BY CASHIER PLUMBING PERMIT NO. THIS PERMIT VALID UPON RECEIPT OF PERMIT FEES Saml c uvn onlncl 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 REOUIRED 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 I CERTIFY THAT I HAVE HEAD THIS APPLICATION AND THE LIST OF PROHIBITED 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 Initial SIGNATURE OF PERMITTEE "" b OPrwner ❑Plumber ❑Owner's ❑Contractor Agent SEWER CONNECTION REOUESTE D: Budding ADDITIONAL INFO PHONE ", % - 'DATE( - STREET []EASEMENT ALLEY ❑61N LATEF COUNTYINSTALL ❑ EXISTING O LATERAL 7NTRACTORINSTALL ❑ Exrstinq Bldg, on Septic ❑ Change m use ❑ Addition ITo Bldg.) ❑ Demolish and Rebu.ld THOMAS EROS' MAP LI Single F:Imdv Dwelling `❑/ Apartments/ Duplexes E] Condommums ❑ Mobile Homes 4 Br. E 7 Br. 2 Br, Number of Condo. or Mob. i Br. DPLU ADDRESS- WORKSHEET ATTACHED ❑Other ?LU FILL IN SIGNATURE DPL PLAN CHECK NO. 5201 Ruffin Rd. ❑ San Diego, CA 92123 565 -5920 FUND FUND NO. ASSESSORS PARCEL NO. TOTAL ANNUAL SEWER SERVICE CHARGES THIS $ PARCEL DPW Fill In SEWER LINE STREET 4 WIDTH LATERAL LOCATION SEWER II Mo. Ds. Yr. DEPTH ❑ EXTRA WIDTH FEET m m m ❑ EXTRA DEPTH FEET Fmel InspeLi D.ne PREVIOUS EDUL -i L. 1-1 EDO THIS PERMITI I TOTAL EDU ON PARCEL DPW Fill in TOTAL CONSTRUCTION FEES 5 - TOTAL CAPACITY FEES 5 REIMBURSEMENT AGREEMENT NO I�T� ❑ TRUNK LINE /PUMP $I I I_ I I- I I I© FEES & EDU VERIFIED: I�'� O DEPT. OF PUBLIC WORKS uf I_� J� 5555 OVERLAND AVE. FEESVALIDFOR AVS SAN DIEGO, CA 92123 OR UNTIL 565 -5332 i6ater SIGNATURE DPW Fill in ANNUAL SEWER S _.. SERVICECHARGES _ THIS PERMIT ONLY DPLU FILL IN ElPRORATA PORTION SEWER SERVICE CHARGES FOR BALANCE OF TAX YEAR(S) TOTAL SEWER SERVICE CHARGES THIS PERMIT $ DPLU FILL IN, TOTAL PERMIT FEES IAIBICID - EI $1 I I_ I I I I I© � j�' DPW FIII in _ 1�� ORIGINAL PERMIT THISPEHMIT DATE / - ❑ San M a Vera Cruz 92069 CALL 5655657 FOR LATERAL CONSTRUCTION 741 -4236 RESIDENTIAL PERMIT DESCRIPTION ❑GRANT DEED -DOC NLEGAL LOT SPLIT ❑CERTIFICATE OF COMPLIANCE PARCEL MAP ❑ BOUNDARY ADJUSTMENT SUBDIVISION NAME ❑ OTHER MAP NO BL LOTS SITE A RESS LI Single F:Imdv Dwelling `❑/ Apartments/ Duplexes E] Condommums ❑ Mobile Homes 4 Br. E 7 Br. 2 Br, Number of Condo. or Mob. i Br. DPLU ADDRESS- WORKSHEET ATTACHED ❑Other ?LU FILL IN SIGNATURE DPL PLAN CHECK NO. 5201 Ruffin Rd. ❑ San Diego, CA 92123 565 -5920 FUND FUND NO. ASSESSORS PARCEL NO. TOTAL ANNUAL SEWER SERVICE CHARGES THIS $ PARCEL DPW Fill In SEWER LINE STREET 4 WIDTH LATERAL LOCATION SEWER II Mo. Ds. Yr. DEPTH ❑ EXTRA WIDTH FEET m m m ❑ EXTRA DEPTH FEET Fmel InspeLi D.ne PREVIOUS EDUL -i L. 1-1 EDO THIS PERMITI I TOTAL EDU ON PARCEL DPW Fill in TOTAL CONSTRUCTION FEES 5 - TOTAL CAPACITY FEES 5 REIMBURSEMENT AGREEMENT NO I�T� ❑ TRUNK LINE /PUMP $I I I_ I I- I I I© FEES & EDU VERIFIED: I�'� O DEPT. OF PUBLIC WORKS uf I_� J� 5555 OVERLAND AVE. FEESVALIDFOR AVS SAN DIEGO, CA 92123 OR UNTIL 565 -5332 i6ater SIGNATURE DPW Fill in ANNUAL SEWER S _.. SERVICECHARGES _ THIS PERMIT ONLY DPLU FILL IN ElPRORATA PORTION SEWER SERVICE CHARGES FOR BALANCE OF TAX YEAR(S) TOTAL SEWER SERVICE CHARGES THIS PERMIT $ DPLU FILL IN, TOTAL PERMIT FEES IAIBICID - EI $1 I I_ I I I I I© � j�' DPW FIII in _ 1�� ORIGINAL PERMIT THISPEHMIT DATE / - ❑ San M a Vera Cruz 92069 CALL 5655657 FOR LATERAL CONSTRUCTION 741 -4236 RESIDENTIAL PERMIT MAP OF SEWER LATERAL LOCATION LATERAL LOCATION CONSTRUCTION INFORMATION RELEASED FOR CONST. 19 _ By ....................... STARTING DATE ................... COMPLETION DATE.......... . EMPLOYEE CLASS HRS a3BWf1N llW83d S' '/_ 9 BS3aOOH 3115 MECHANICAL EQUIP. HRS. OR MILES MATERIAL QUAN. ,il.,C I � 357 G /h THOMAS BROS. MAP _m UTILITIES CHECK Name Date By Water Gas Elec. Tele. TV a3BWf1N llW83d S' '/_ 9 BS3aOOH 3115