HomeMy WebLinkAbout1571 BASSWOOD AVE; ; SE679891; Permit-* BUILDING DEPARTMENC?
NO.
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FOR APPLICANT TO FILL IN
3% LEGAL DESCRIPTION LOT NO. I
LICENSE NO. LICENSE NO.
DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO PUBLIC SEWER 8 $3.00 /-3p
SEPTIC TANK. SEEPAGE PIT OR PITS Q $5.00
OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. CESS~OOL, DRYWELL. MANHOLE 8 $5.00
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.50
CONNECT ADDITIONAL BLDG. OR
ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 8 S2.00,
WORK TO HOUSE SEWER 8 $1.50
B)$ I I II
OWNER'S I PERMIT I/ ,Flu"
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD. ING TO THE PUBLIC SEWER.
AUTHORIZATION TOTAL FEE
SIGNED THIS DAY 6F OWNER OR OWNER'S AGENT
a>- -. PERMIT APPUCA-
I ADDRESS
CITY TEL. NO.
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = ___ 6" = -
Add. Horiz. @ 4" = - 6" = ___
Add. Vert. @ 4" = __ 6" = __
Total Construction cost
L
10% Service Charge
Total Laferal Charge
Let. No.: Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:
C. C. 8- / dwelling
P. S. 8- / dwelling __r
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. OPERLY REGISTERED THE CITY OF CARLS- HAT I AM THE LEGAL RESIDENTIAL PROP
SIGNATURE OF PERMITT
rly Filled Out,
PERMIT VALIDATION
si. ' NORTH! I ENGINEERING SEWER DEPT,
Signed I Signed
Signed and Validated
.- - -- -__ ._I_-
WILDING DEPARTMENT
...-.- ADDRESS 1 I
A
LICENSE NO. LICENSE NO.
TOILET 0 $1.25 - BATH TUB 8 ¶.25
SHOWER 8 1.25
WASH BASIN 8 1.28
KITCHEN SINK Q 1.28
DISHWASHER @ 1.25
LAUNDRY TUB OR TRAY 0 1.25
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I
/ ,. AUTOMATIC WASHER 8 1.25 ‘) WATER HEATER 8 VENT @ 1.50
.30 EA. ADD. 8 1.50 1 GASSYSTEM I TO 15
I
FLOOR DRAIN OR SINK @ 1.25
LAWN SPRINKLER 0 2.00
MISC. WATER PIPING 8 1.50
GARBAGE DISPOSAL 63 1.00
VACUUM BREAKER OR BACK FLOW DEVICES 1 TO 5 @ 2.00 ‘
PERMIT f I TOTALFEE $
GRADING PLAN
YES
-I- F
I ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGUSTING PLUMBING.
I CERTIFY THAT I AM PROPERLY REGISTERED AND Ll- CENSED AS REQUI OF WRLSBAD AND STATE OF CALIFOR THE LEGAL OWNER OF THE ABOVE DES AL PROPERTY.
SIGNATURE OF PERMITTEE
BU l LDl NG ADDRESS
NEAR EST CROSS ST.
1
GROUP 1 ZONE Inspection Record
APPROVALS t DATE I INSPECTOR’S S1ONATUR.I
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
PLUMB1 NG FIXTURES
MISC.
GAS TEST -
UTILITY CO. NOTIFIED
3L -c
’VALIDATION sr&+ When Properly Filled Out, Signed and Validatsd.
is not commenced within 60 days of date of issuance.