HomeMy WebLinkAbout1675 BASSWOOD AVE; ; SE669485; PermitBUILDING DEPARTMENT
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
SEPTIC TANK, SEEPAGE PIT OR PITS 8 $5.00
PUBLIC SEWER 0 ,ss.oo 1
948'
rj, 7 6 -
a , ',J
CESSPOOL. DRYWELL. UANHOLS O 15.00 ,
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.50
CONNECT ADDITIONAL BLDG. OR
FOR APPLICANT TO FILL IN I
I-
LEGAL DESCRIPTION LOT NO.
PERMIT OWNERS
AUTHORIZATION
I
BUILDING ADDRESS
NEAREST CROSS ST.' A
OWNER
MAIL ADDRESS 1
TEL. NO.
$300
CONTRACTOR'S. STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. 1 I
WORK~TO HOUSE SEWER 0 r1.so
ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2.00
I HAVE Ar 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
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. 8 4" = __ 6" = -
Add. Horiz. Q 4" = ___ 6" = ___
Add. Vert. @ 4" = ___ 6" = -
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. 5. d- / dwefling
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
st. NORTH
ENGINEERING SEWER DEPT.
Signed I Signed
is e Sewer P it When Properly Filled Out, Signed and Validated
Issued By - PERMIT VALIDATION
' ,./
-
BUILDING DEPARTMENT
OWNER
MAIL ADDRESS- II
TEL. N~.7w-2zi4.
CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
2- TOILET @ $1.25
BATH TUB 8 1.25
SHOWER @ 1.25 - 7 WASH BASIN 8 1.25
/ KITCHEN SINK @ 1.25 9 DISHWASHER Q 1.25
LAUNDRY TUB OR TRAY Q 1.25
/ AUTOMATIC WASHER 8 1.25
/ WATER HEATER B VENT 8 1.50 r GAS SYSTEM 1 TO 15
r
.so EA. ADD. 8 1.50
FLOOR DRAIN OR SINK @ 1.25
LAWN SPRINKLER @ 2.00
MISC. WATER PIPING @ 1.50
t-
GARBAGE DISPOSAL @ 100
VACUUM BREAKER OR BACK FLOW DEVICES 1 TO 5 200 Y --I
PERMIT s I TOTALFEE $
GRADING PLAN
YES 0
I--- -1-
-rlrrr
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 PLUME I NO.
,e
3
BUILDING ' ADDRESS
NEAREST CROSS ST.
I I ZONE GROUP
Inmection Record
APPROVALS 1 DATE 1 INSPECTOR'S SIGNATURE
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
PLUMBING FIXTURES
MISC.
I CERTIFY THAT I AM PROPERLY REGISTERED AND LI- Y OF GARLSBAD AND
OF THE ABOV
SIGNATURE
Permit void if work is not commenced within 60 days of date of
GAS TEST
-
Validated.
issuance.