HomeMy WebLinkAbout1635 BASSWOOD AVE; ; SE669547; PermitBUWING DEPARTMENT
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION LOT NO.
LICENSE NO. LICENSE NO.
I @$ I I
OWNER'S
AUTHORIZATION
I HAVE AT TXlS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- ING TO THE PUBLIC SEWER.
SIGNED THIS DAY 6F OWNER OR I OWNERS AGENT
ADDRESS
I 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. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED THE CITY OF CARLS- HAT I AM TXE LEGAL RESIDENTIAL PROP
PERMIT - APPLICATION 95L:
BUILDING ADDRESS
NEAREST - CROSS ST.
CONNECTION DATA
Ldbrdl Charge Computdtion
30' H., IO' V. @ 4" = - 6" = ___
Add. Horiz. @ 4" = __ b" = -
10% Service Charge
Total Lateral Charge
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assrnt. No.
LINE COST:
C. C. Q- / dwelling
P. S. @- / dwelling
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
St. NORTH
ENGl NEERl NG SEWER DEPT.
Signed I Signed
dy Filled Out, Signed and Validated
rssuad B~
PERM IT VALIDATION *
~ ._I.__I_._,._____.._...... --
BUILDING DWARTMENT PERMIT - APPLICATION
BUILDING */ ADDRESS . .+-a
NEAREST CROSS ST.
I I ZONE GROUP
Inspecfion Record
M -**ut.
LICENSE NO. LICENSE NO.
ITEM I FEE
8 51.25 z
BATH TUB 0 1.25 z, J7>
WASH BASIN dD 1.25 3 7 J--
SHOWER Q 1,2s
KITCHEN SINK 0 1.25
DISHWASHER B) 1.25
LAUNDRY TU0 OR TRAY B) 1.25
AUTOMATIC WASHER @ 1.25 j 2J'-
WATER HEATER e VENT 8 1.50 f 3-D
@ 1.50 / GAS SYSTEM 1 TO I5
FLOOR DRAIN OR SINK 8 1.25
LAWN SPRINKLER 0 2.00
MtSC. WATER PIPING @ 1.50
.SO LA. ADD.
GARBAGE DISPOSAL 0 1.00
VACUUM BREAKER OR BACK FLOW DEVSCES 1 TO S 0 2.00
GRADING PLAN s200
.I 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.
I CERTIFY THAT I AM PROPERLY REGISTERED AND Ll-
STATE OF CALI OF THE ABOVE
VALIDATION
APPROVALS DATE
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
INSPECTOR'S SIGNATURE
PLUMBING FIXTURES
MISC.
GAS TEST
FINAL
50