HomeMy WebLinkAboutSewer connection app and permit, 520 PacificCITY OF TUSTIN
SEWER CONNECTION PERMIT FEES CALCULATION FORM A
For
SINGLE FAMILY OR MULTIPLE UNIT TYPE RESIDENTIAL DEVELOPMENTS
VALID JANUARY 1, 1971 THROUGH JULY 1, 1971
Date �� 7/ Calculated by -D
Owner or Developers name>cic�6-11 T�r�[e
Address of house or location of project connecting G Gc=ir=+c
Legal Description 4P41 -,6
Type of Sewer Connecting to - Check One:
Orange Co. Sanitation District No. 7 Trunk Sewer_
City of Tustin Sanitary Sewer
Remarks -,.tUti>c 1T _To 0:5 -_%Per
FEE CALCULATIONS
Instructions: If connection or connections are made direct to an existing
Orange County Sanitation District No. 7 Trunk Sewer, fill out "Trunk
Connection Charge." If connection or connections are made direct to an
existing City of Tustin Sanitary Sewer or direct to a sewer constructed by
the developer for the City of Tustin, fill out "Regular Connection Charge."
Enter N.A. where not applicable.
REGULAR CONNECTION CHARGE
(1) Number of dwelling units connecting with kitchen
X $100.00 --------------------------------------------- $
(2) Number of dwelling units connecting without kitchen
X$50.00 ---------------------------------------------- $/(1,�.
TRUNK CONNECTION CHARGE
(1) Front Feet 15-0 X $6.00 = $ or$400 00
Enter whichever amount is greater-----------------------------$_3�je"-
(2) Number of dwelling units connecting with kitchen--_-- C1c
r X $100.00---------------------------------------- $ 1616.._
(3) Number of dwelling units connecting without kitchen
X$50.00 ---------------------------------------------- $ —
CC
TOTAL CONNECTION PERMIT CHARGE ---------------------- $ �':
SEWER CON,4ECTION APPLICATION AND PERMIT
(AREA DEVELOPMENT—SINGLE OWNERSHIP)
CITY OF TUSTIN
136 W. Third St.
Tustin, California
APPLICATION
To be completed by owner or agent and submitted in quin-
tuplicate with required fees and plans — see reverse side
Applicant, _ <5&et2C,-6 / (51 V&rr2D hereby requests the
following connections) to City's sewerage facilities:
Location Lot Nos. Size Type
(See reverse side for instructions)
X To (!�?�' ;�t+- • it d P` Fc.r c
2. Lr. -?C C. -C �V4.A.: CT704J
3.
To
Tract No. Total lots estimated date of occupancy
If commercial or industrial property, total acreage served
The waste to be discharged to City's sewerage facilities, if other than purely domestic sewage will have the
following general characteristics as to estimated quantities, time of peak discharge and principal source or sources:
In making this application, applicant acknowledges that any permit issued will constitute a contract, if accepted by
applicant,, and may a enforced by civil action at law and/or injunction.
Date:__ & %
SIGNATURE
PERMIT No—
For Connection to City Sewerage Facilities
and for Discharge of Domestic Sewage Orly
Permission to construct connection(s) to the sewerage facilities of the City is hereby granted to applicant providing
such connection(s) is made in accordance with plans and specifications hereby approved, and attached hereto;
further providing that request for inspection must be given to the Tustin City Hall (544-7820) at least 24 hours prior
to the commencing of any construction work.
This permit also gives the applicant permission to discharge only purely domestic sewage through the con-
rection(s) hereinabove authorized into the sewerage system of the City. The discharge of any industrial or commer-
cial waste is not authorized without a further and separate permit from the City.
Receipt of required fees and charges as specified by Orange County Sanitation District No. 7, Ordinance No. 705
is hereby acknowledged.
Date' 4/ 7 CITY 0F.OIJSTIN
co
Amount Paid $__�Q By