HomeMy WebLinkAbout1342 MAGNOLIA AVE; ; 76-409; Permit--. 0 ()
BUILDING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008 --,/
Permit No. Applicant to complete numbered spaces only. Phone 729-1181
JOB AODR £55 ASSESSOR'S
-· 1) /11 A I':-J.ln .L IA P ARCEL NUMBER
, ,OT NO. ,•L~" ,._.CT BOOK PAGE I LC.GAL ,,1 fi , ~t .:z fj 0sec ATT.-.CHCO ~H(LTI 1 OC$C•. I
OWNC" MAIL ADDLll:£SS ZIP PHON[
2 ~ t"':'T ~. ,:rL_i(.14 fl-4r'S I .SN .. q ,tJ }ll ,. (; Al l' A [? tKHlA c;~ c.c ·-
CONTRACTOR '0 • MAIL AOOAESS PHONE LICENSE NO, ST ATE
3 Al ER
A "CMITECT Ofl'l DESIGNER MAIL AOOIII ESS PHONE LICENSE NO.
4
[NGINE[R MAIL •ooR ES5 PHONE LJC[NSC NO.
5
COMPENSATION INS, CARRIER MAIL AOOllt(SS &,tANCM AJ 6
USC o, BUILDING ~ I.JI' 1 7 ' -flu 8 Class of work: □NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE 'V \
I
PAR,
CITY
11
9 0 escribe work : t1no n F-t..A Mt (OIV f'T. ~,II,:.' r., L £" 1?r:n~ 5"7~ r rr, I •• 7i" -
10 Change of use from
Change of use to
11 Valuation of work: $ ~~ /If ,2 t."' (:)
I ~. C
PLAN CHECK FEE 8 PERMIT FEE $
SPECIAL CONDITIONS: MICRO FILM FEE Type of I.J Occupancy -1' Const. Grou p
Size of Bldg, N o. of , Max.
(Total) SQ. Ft '(,, Stories 0cc. Load -
Fire _.,? Use Fire Sprinklers
APP LI CA TrOI\I ACCEPTED ev PLANS CHECi<ED BY APPROVED FOR ISSUANCE BY Zone Zone ReQulred OYes ~No
No. of / OFFSTREET PARKING SPACES, r. Dwelling Units No. !No. OATE DATE Covered SQ. Ft. Open
NOTICE Special Approvals Required Received Not ReQuired
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-PLANNING DEPT.
ING, HEATING, VENTIL ATING O R AIR CONDITIONING. HEALTH DEPT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN120DAYS, OR IF FIRE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ENGINEERING DEPT. APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.
ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WATER DEPT.
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
..
51GNATURlt or CONT .. ACTOIIII Oft A.UT'"IOIIIZ.E.0 AGCNT !DAT()
SICiNATlll'I[ 0" OWNEl't 1,-OWNCfllll IUILOCfllll) DAT[)
WHEN PROPERLY VALIDATED ON THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH -:? 17 ..,-·a
INSPECTOR
L
INSPECTION RECORD 1~-lf{)9
DATE REMARKS INSPECTOR
FOUNDATIONS:
SET BACK
TRENCH
REINFORCING
FOUNDATION WALL &
WEATHER PROOFING '
CONCRETE SLAB
FRAMING
INT. LATHING OR DRYWALL
EXT. LATHING
MASONRY
I\ '\ /1, ., /
FINAL to\ I\~\ V\ff\ ~ w
\, \J ~
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
8-24-76 Footings will be stepped for non slippage effect on north and soutr
footings only. Block foundation will be reinforced for surcharge and ---
vertical load where needed . Also wants to change roof line. T. !1ata -----
____ 1..,.l~-__,,3,__,0._-16 Steel-l\11 s teel is in, he is ready to g r out a nd add s teel for
t y ing int o s l ab when he pours s l ab out . Looks good . T. r-1a t.
---------------------------
REQUEST FOR INSPECTION TIME: ______ _
BUILDING
0 FOUNDATION
0 REINFORCING STEE:L
0 MASONRY
0 GROUT -GUNITE
0 FLOOR AND CEILING FRAME
0 SHEATHING ·.. ~
•, ' 0 FRAME '
0 EXTERIOR LATH
0 INSU ATION
0 OR DRYWALL
PLUMBING
0 UNDERGROUND PLUMBING
0 UNDERGROUND WATER
0 ROUGH PLUMBING
D TOP OUT PLUMBING
0 SEWER AND PL/CO
0 TUB OR SHOWER PAN
0 GAS TEST D ;i,'.'ER HEATER i6" FINAL
READY FOR INSPECTION: ~NDAY
~
_____ DATE: ::5:-,2; ... 7,
ELECTRICAL
~ '0 TEMPORARY SERVICE
0 ELECTRIC UNDERGROUND
0 ROUGH ELECTRIC
0 POOL BONDING
0 ELECTRIC SERVICE
0 CEILING HEAT
0 G.F.1.
0 S_J,10KE DETECTOR
~ FINAL
MISCELLANEOUS
0 PLENUM AND DUCTS
0 COMBUSTION AIR
0 PATIO
D SIGN
0 GRADING
D DRIVEWAY
D CONDITIONED AIR SYSTEMS
D ~ER PIPING
(2('" FINAL
□TUESDAY □WEDNESDAY D THURSDAY D FRIDAY
SPECIAL INSTRUCTIONS ___________________________ _
REQUESTED BY __ /3 __ ......,,.;,.;r;; _ _,,_ ____________ PHONE NO.~
PERSON TAKING REPO~..._r.,,._,,,.c...&A"""~ ....... """""---
==:::~
ail O I-7° 1~ euut-
CA.il ~ V :;7
rat¥L~rYi/
5', ~/-7 J
G PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
.. 7d' -?{/ If::~ ;O Applicant to complete numbered spaces only.
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Jo• ADO" c• "!,
I .S
l L(OAl· 1 DtSCJIII
LO'T NO
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OWN CA
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"\ "'...., 3
AfllCHITCCT 01111 OCSICiNC,-I 4
[NOINCC.R \,...,,. 5 --
COMPENSATION INS, CARRIER
6
US[ OF BUILDING
7
Phone 729-1181
I TUCT \ \
MAIL ADD .. CSS
) ( , ....
ZIP
\
MAIL AOOJIIICSS ..., PHONl
MAIL AO0"l59 PHOH[
MAIL AODAt5S PHON[
MAIL AOOIIICSS
NO. BORMS
P.erintl No.
• ASSESSOR'S
PARCEL NUMBER
PAR. c[lscc ATTACHCO SHCCTI PAGE I
PHONE
II:
STATE LIC, NO. CITY LIC. NO,
7
LICENSE NO.
LICEN9l NO,
NO. BATHS
8 Class of work: □NEW 0 ADDITION □ALTERATION □ REPAIR □ MOVE 0 REMOVE
9 Describe work.
u <J
10 Change of use from
Change of use to
11 Valuation of work: $ PLAN CHECK FEES
,_S_P_E_C_I_A_L_C_O_N_D_I_T_I_O_N_S_. ___________________ Type of
Const
t------------------------------1 Soze of Bldg (Total) Sq. Ft
1-----------.-----------. ..... ----------1 Fire
NOTICE
APPROIIEO FOR •SSUANCE BY -~
DATE/, ~ '4
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB•
ING. HEATING, VENTILATING OR AIR CONDITIONING.
Zone
N o. of
t;>we111ng Units
Special Approvals
PLANNING DEPT.
Occupancy
Group
No. Of
Stories
MICRO FILM FEE
Max.
0cc Load
use Fire Sprinklers
Zone Required OYes DNo
OFFSTREET PARKING SPACES
No. Covc,red
Required
Sq. Ft.
Received
I No, Open
Not Required
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM
MENCED.
HEALTH OEPT ----1--------+-------+---------1
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER SlATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION,
Sl~NATUOt o, CONTOACTO: 00 AUTHOOlttO ¼r (DA Tl)
~ll;NATU"[ 0~ OwNr .. I,. OWN[Jt IUILOllll OAT[)
FIRE DEPT
SOIL REPORT
OTHER (Specify)
ENGINEERING DEPT
WATER DEPT.
WHEN PROPERLY VALIDATED (IN THIS SPACE} THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK . M.O.
TOTAL FEES$
INSPECTOR
CASH
1r ELE.CTRICAL PERMIT APPLICAflS~ I '11
21 .00 8-P
6.00 TL
City of CARLSBAD, CALIFORNIA 92008
Applicanttocompletenumberedspacesonly Phone 729-1181 Permit No
JOB ADDRESS
/ 3L/ 2_ \ .0 o t \ ;~ 1\ J (i I LDT NO, I BLJ(, I TRACT (QSEE ATTACHED SHEET) LEGAL ~ .. , 1 OESCR. I ~~ 1 ..... '-· (,) ~ ' .-
OWNER MAIL ADDRESS ZIP PHONE
2 l, ..,--\.. ' I 1'39"1 )1/,,, v) t-lv .. -I 7 :)', I. ~-( I\ iflK .... ., 4( (,. -JI•.,~--J \
CONTRACTOR
(r'1
f MAIL ADDRESS ~ PHONE STATE LIC. NO, C ITV LIC. NO,
3 +,:-~ F,,. C r (_ f(.I 1.Jcti .... J: ~ }Sci J • i. {.,I ...., r ~ ... ,.,;-/' . ' ,
ARCHITECT OR OESIGNER MAIL AOOR ESS PHONE LICENSE NO.
4
ENGINEER M AIL ADDRESS PHONE LICENSE HO.
5
COMPENSATION INS CARRI ER -MAIL ADDRESS BRANCH
6 .
-. 7
USE OF BUILDING / 7 ( j) -
8 Class of work: [)(NEW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work:
--PERMIT FEES
No. Each Fee
SPECIAL CONDITIONS: SWIMMING POOL WIRING,
NO INCREASE IN SERVICE
NEW CONSTRUCTION, FOR EACH
APf'LICATION ACCEPTED BY '~ANS CHECKED BY APPROVED FOR ISSUANCE BY AMPERES OF MAIN SERVICE, SWITCH,
FUSE OR BREAKER /( ('
,,. _;,s -~-I ;I t5 DATE NEW SERVICE ON EXISTING BLDG.
NOTICE FOR EA. AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUC-OR BREAKER
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 OAYS,OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM REMODEL, ALTERATION. NO CHANGE
MENCED. IN SERVICE, FOR EA. AMPERE OF
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS INCREASE APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCE!, GOVERNING T HIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT TEMP. SERVICE UP TO AND INCLUD· PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
TEMP. SERVICE OVER 200 AMP.
\ -, ~ PER 100 . ]-7\~,6 . ~•\. \
SIGNATURE OF CONTRACTOR OR AUTHOR I ZED AGENT (DATE)
ISSUANCE FEE /
TOTAL FEES 5 1r..N•TuRE Ut oWNEN IF OWNER BUILDER) IOATEl
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
INSPECTOR
~/1-.,/7) J " :!2.00 BP
PLUMBING PERM IT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete nl{mbered spaces only. Phone 729-1181 Permit No. 7 9-11/ ~)-,--"
JOI AODR CSS
I " , r-11104 A., \! \ ) -! I
LOT NO. I I I LK , , .. ,,
LEGAL 'l 1 DESC~. .,)
OW N£111 r .lj J "/(\J.v .,., L •oo•n• I 11P P HONC
2 ) ,#Jc, ' \ Oe' '~ /1\,
C:ON TJIACTOJI ' M,I.IL A0 011t[S!i , PHON t STATE LIC, NO, CITY LIC, NO.
3 1,
AftCHITCCT OJII OC51GNCJI M AIL AD01'1[55 PHON E l.lCEN5E NO,
4 ,
ENGINE[" I MAIL AOOIIU.SS PHONE LIC(NSC NO.
5
COMPENSATION fNS. CARRIE) MAIL Aoo•css 811U,NCH
6 . •.
use 0,. l!IUH.OI NG J 7
8 Class of work: □NEW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work:
PERMIT FEES
N o. Type of Fixtu re or Item Fee
SPECIAL CONDITIONS. WATER CLOSET (TOILET) $
BATHT UB
LAVATORY (WASH BASIN)
' SHOWER
I K ITCH EN SINK & DISP
f DISHWASHER -· APPLICATION ACCEPTED BY PLANS CHECKED 8Y APP~Ovtt> ~,O'r< ISSUANCE BY LAUNDRY TRAY --,.,,, ·--·" I CLOTHES WASHER # ""'((V (..,
~ , -DATE I WATER HEATER
NOTICE tr,' 1 1-URINAL
THIS PE RMIT BECOM ES NU LL A ND VOID IF WORK OR ONSTRUC• DRINKING FOUNTAIN
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF FLOOR-SINK OR DRAIN CONSTRUCTION O R WO RK IS SUSPENDED O R ABA NDONED FOR A
PERIOD OF 120 DAYS A T A NY TIME A FTER WO R K IS COM SLOP SINK II
MENCED. I I H EREBY CERTIFY THAT I HAVE REA D A N D EXAMINED THIS GAS SYSTEMS NO. OUTLETS ,.
APPLICATION AND KNOW THE SAME TO BE T RUE AND CORRECT WATER PIPING & TREATING EQUIP. A LL PROVISIONS OF LAWS ANO ORDINANCES GOVERNIN G THIS T YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED W ASTE INTERCEPTOR H EREIN OR NOT, THE GRAN TING OF A PERMIT DOES NOT
PRESUM E TO GIVE A UTHORITY T O VIOLATE OR CAN CEL THE VACUUM BREAKERS PROVISION S OF A N Y OTHER STA TE OR LOCAL LAW REGULATIN G CONSTRUCT ION OR T H E PERFORMANCE OF CONSTRUCTION. LAWN SPRINKLER SYSTEM
SEWER NUMBER CLEANOUTS I ~ -· if ' I ) t. I I CESSPOOL
SEPTIC TANK&, PIT
)1 ROO F DRAINS
SIGNA TVPtE o, CONT,tACTO" Ott AlJTHOptl l EO AGENT (DATE}
/,~ ISSUANCE FEE $
A ~ TOTAL FEES $ : . --51GNA Tl1'1£ OP' OWN[,t tr OWNtllt BU !LOE.Ii) (DA.TC)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M .O. CASH PERMIT VALIDAT ION CK . M.O. CASH
INSPECTOR
'5/ f ~/7 J "
MECHANICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only Phone 7 29-1181 Permit No
JOB ADD,-~.SS
I /r "i J. :~
LOT NO.
L[ OAL I 1 ouc•. / IILK I T•ACT tOsrc ATT.ACMEO SHttT)
-OWNCfl J ~AU-v' 2
CONTJIIIIACTOR u 3
AJIIIICHITECT Ofll DCSIGNU,
4
CNGINttR
5
LENDlllt -6 -
USC o, IUILDING ( U. 7
-MAIL ADDRESS ,t '-1,. l~ Z_I P
MAIL ADDRESS I PHONE
MAIL ADOJlESS PHONE
MAIL AO0" [55 PHONE
,,,U,IL AODIIIESS
PHONE
STATE LIC, NO,
i
LICENSE NO,
LICENSE NO.
llliANCH
I}
8 Class of work: QNEW 0 ADDITION 0 ALTERATION 0 REPAIR
9 Describe work:
Type of Fuel: Oil D Nat. Gas D LPG. 0
PERMIT FEES
SPECIAL CONDITIONS. No. Type of Equipment
Air Cond. Units-H.P. Ea.
Refrigeration Units-H .P Ea.
Boilers-H.P. Ea.
Gas Fired A .C. Units Tonnage Ea.
Forced Air Systems-B.T.U. M Ea.
APPLICATION ACCEPTED BY PLANS CHECKED BY APPRO~J) £PR ISSUANCE BY Gravity Systems-B.T.U. M Ea.
Floor Furnaces-B.T.U.
/ ~ Wall Heater~-B.T.U .
M
M
M NOTICE U .._ ,../ ,. Unit He;.ters-B.T.U.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTf\0(1 ,M--+---E-1111_p_o_r_at-i11_e_C_o_o_l_er_s __________ _
TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS,OR IF 1 CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A Clolhes Dryers
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TD VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
I () (}
::'\. i (DAT£)
. V Jf
TUflt. o, OYitNUI ,, OWNIUI au1L0■11 DA [
I Ventilation Fan
Range Hood
Air Handling Unit-
Incinerator
"WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK.
INSPECTOR
C.F.M.
ISSUANCE FEE
TOTAL FEES
M.O.
13.00 BP
CITY LIC, NO.
Fee
$
6'f -
.I
u:
s
s /
CASH
INTt:.HUt:~AK I Mt:N I AL rn1runmM 11v,,,. ... , ,.._.._,
\JG DEPARTMENT RECEIVED
~1G ADDA Ess: __ ._A/:._:.J::........½c.....~,.c:,..--L-?fa..14,..1,,a,0+-"a_.......1~~&!:;,.=.,:o,;.=..µ _____ --==-=-------
/ FEB 2 1976
1 f Building Department
JING DEPARTMENT 1J ~
IZE OT WIDTH wn \le .. ZONE N=Jv
1 CITY OF CARLSBAD
PROVIDED \ ALLOWED / \ PRKG. SPACES PROVIDED -1 ~ REQ. __
COVE RAG E--r-,/----+-\A_L_L__.OWEO ✓ \ BLDG. HEIGHT ---1i..:.._A LL::D //,j61
r SETBACK -..J SIDE YARD • J RE~YARD __ J ___ IIINTRUSIONS ~
'ONMENTAL PROTECTION ~EQ'TS. ~e '\/'i LANDSC w" -
JEERING DEPARTMENT
___ ....,E..4i, .... r_.S"t-t.._ ..... N=<,;._____ _______ INDUSTRIAL WASTE ___ N_._/-J_. _______ _
If' /__
) VE MEN TS Fett -A.free B.":\ fi:.M r:: SEWER CONNECT IO N_,,=~ .... 5'i,_,o'-Cf"-----+-(.?.=-:. e:....;;ce'---c-=-·c,.a.a,.,,..:....am'-'-.il.=...:p.=· ·_-~)_
:WAY LOCATIONS __ O~K._. _____________ GRADING PERMIT ______ _
v1 E NTS ____ eow:.w.::e...1.,0a.... _____________ D RAI NAG E ___ :f....._c:>=-"""'S"-1'--'-'U'-"--'-rz_'--..... 1 __
L DESCR I PTION __ p_._1+_,_,(Lc.c..-~#_·3~ __ P_M~~tt-44+--t---'"'~~l.c...) ------------
r,ONAL COMMENTS Scwf:i...'2-A-No w A-i-<n.... -;36.'4/tle 'PA,~ ea a, '3v MS# -:2..fag
\ L f)p.. I tJ~i'TA--L!..l~D Q '( C.t''t-'1 Ut-'Oi',..l :;J.. WQ.(L~ "10"1-1((2
PERMIT e me: Y\?<.d DATE 1./ "b) l1L OCCUPANCY ([102' t DATE 2-1, ~lzr
DEPARTMENT
JKLING SYSTEM _____________________________ _
PROTECTION EQUIPMENT ____________ FIRE ALARMS ________ _
) __________________________________ _
HYDRANTS ___________ _ LOCATION _____________ _
TIONAL COMMENTS ____________________________ _
: PERMIT _______ DATE ______ OCCUPANCY _____ _
ER DEPARTMENT
11T _______ DATE ___ ----,:
"'ING -------. DEPT. ______ _
.DG. --------RETURNED TO BLDG. DEPT. ____ _
' .
... -~ .
APPLICATION FOR PERMIT TO CONNECT TO CITY SEWER SYSTEM
CITY OF CARLSBAD
ENGINEERING DEPARTMENT
729-1181 EXT. 35
FOR APPLICANT TO FILL IN
BUILDING
ADDRESS
OWNER
MAILING
ADDRESS
CONTRACTOR
CONTRACTOR'S
ADDRESS
I NEW BUILDING EXISTING BUILDING r . LEGAL DESCRIPTION
REMARKS:
'\
LATERAL LOCATION
ST.
...,:
(/)
LATERAL NO, _______ INSTALLATION DATE----------11
' SE . 1751 BUILDING DEPT.
ISSUED BY _________________ _
DATE ISSUED ___ -<--=...-_,:2()....::::..._# __ 7.L..£(.o=--------
VALIDATION
LATERAL CHARGE COMPUTATION
STANDARD 4" (Max. H. 30', V, 10') _________ _
OVER 30' H. ___ @s::,.__ ___ FT. _________ _
OVER10'V. @ FT. _________ _
STANDARD 6" (Max, H. 30', V. 10') _________ _
OVER 30' H. ___ @1---__ FT,----------
OVER 10' V. @ FT. _________ _
TOTAL CONSTRUCTION COST ----------
SERVICE CHARGE (REPAVING ETC.) _________ _
TOTAL LATERAL CHARGE----------
LINE COST DATA
ASSESSMENT DIST. NO.--------------
FRONTAGE ____ COST PER FT. ____ TOTAL __ _
OTHER ___________________ _
CONNECTION FEE
NO, UNITS--''----COST PER UNIT _;2!5D TOTAL---
PUMP STATION FEES
NO. UNITS ___ COST PER UNIT ____ TOTAL---