HomeMy WebLinkAbout1645 BASSWOOD AVE; ; SE669487; PermitBUILDING DEPARTMENT 948"
FOR APPLICANT TO FILL IN
SEWER
PERMIT - APPLICATION
LEGAL DESCRIPTION LOT NO.
CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
-ZxIQSd ?
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO PUBLIC SEWER 8 $3.00
SEmlC TANK, SEEPAGE PIT OR PITS 8 $5.00
I
. --
OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. CESSPOOL. DRYWELL. MANHOLE @ S5.00
HOUSE SEWER CONNECTING TO
WORK TO HOUSE SEWER 8 SI.SO
I
PERMIT s I TOTAL FEE
OWNER'S
AUTHORIZATION I
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- ING TO THE PUBLIC SEWER.
SIGNED THIS DAY 6F OWNER OR OWNER'S AGENT
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE RGAD 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
OWNER OF THE IBED RESIDENTIAL PROP. ERTY. SIGNATURE OF PERMITTE ~
BUILDING ADDRESS
NEAREST CROSS ST.
OWNER
MAIL I . .. ADDRESS
TEL. NO.
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = - 6" = -
Add. Horiz. @ 4" = - 6" = -
@ 4" = __ 6" = - Add. Vert.
Total Construction Cost
10% Service Charge
Total Lateral Charge
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:
C. C. @- / dwelling
P. S. Q- / dwelling
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
;i/
st. NORTH
ENGINEERING SEWER DEPT.
Signed I Signed
When Properly Filled Out, Signed and Validated
Issued By I
PERMIT VALIDATION
BUILDING DEPARTMENT
I
NO.
2
%
%
I
/
I
CITY TEL. NO.
STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
ITEM F
TOILET Q $1.25 2
WASH BASlN 0 1.28 3
BATH TUB Q 1.25 2
SHOWER @ 1,25
KITCHEN SINK 8 1.25 1
DISHWASHER 1.25 /
1 I
I
WATER HEATER B: VENT 8 1.50
GAS SYSTEM I TO 15 .so CA. ADD. @ 1.50
1.25
2.00
1.50
__ FLOOR DRAIN OR SINK
LAWN SPRINKLER __
__
APPROVALS
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
PLUMBING FIXTURES
M I SC.
GARBAGE DISPOSAL 1.00 A
VACUUM BREAKER OR BACK FLOW DEVICES I TO 5 2.00 ___
DATE I- I I
GRADING PLAN
YES 0
I ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I AM PROPERLY REGISTERED AND LI- CENSED AS REQUIRED BY THE CITY OF CARLSBAD AND AM THE LEGAL OWNER OF THE ABOVE ENTIAL PROPERTY.
ADDRESS BUILDING /L&y- &$
NEAREST ' CROSS ST.
I
GROUP I ZONE Inswction Record
INSPECTOR'S SIGNATURE
1
GAS rEsr
UTILITY CO. NOTIFIED
FINAL
VALIDATION t When Properly Filled Out, Signed and Validated. ot commenced within 60 days of date of issuance.