HomeMy WebLinkAbout2462 LORNA LN; ; 78-3911; PermitPLUMBING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008 5u
Phone 729-1181 , 1 -;t <. 4-,.,-Applicant to complete numbered spaces only. Perm rt No.-.,
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CONTAAC:TO" MAIL ADOftCSS PHON [ STATE LIC. NO. CITY LIC. NO.
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ENGINlCA MAIL AODflt tSS PHON[ LICCNSE. NO,
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COMPENSATION (NS. CARRI ER ""'4AIL AOOflt ESS aAANCH
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8 Class of work: □NEW 0 AD DITION 0 ALTERATION 0 REPAI R
9 Describe work:
PERMIT FEES
No. Ty pe of Fixture or Item Fee
SPECIAL COND ITIONS WATER CLOSET (TOILET) $
BATHTUB
LAVATORY (WASH BASIN)
SHOWER
KITCHEN SINK & DISP
D ISHWASHER
APPLICATION ACCEPTCO ev PLANS CHECKED ev APPROVE O FOR ISSUANCE ev LAUNDRY TRAY
J'f ✓1/~ -, v CLOTHES WASHER
' , .. i ' DATE WATER HEATER
NOTICE U R INAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC DRINKING FOUNTAIN
TION AUTHORIZED IS NOT COMMENCED WI THIN 120 DAYS,OR IF FLOOR-SINK OR DRAIN CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM• SLOP SINK
MENCED. GASSYSTEMS NO.OUTLETS I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. WATER PIPING & TREATING EQUIP. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED WASTE INTERCEPTOR HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE VACUUM BREAKERS PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION LAWN SPRINKLER SYSTEM
,J SEWER NUMBER CLEANOUTS -, CESSPOOL .) " "-~A . ~/4~ L"/4/4 SEPT IC TANK .. PIT
ROOF DRAINS .,, ... (~£ ~~"J"ACT~•·5THO"IUO AGtNT /(OAfl V
ISSUANCE FEE $
TOTAL FEES $ SIGNATUIU, o,-OWN[lll fl,-OWN[lll aVILOlJU tOAT (J . --,.~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT ~ --PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
INSPECTOR
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
NEW BUILDING
LEGAL DESCRIPTION
REMARKS·
yr,/ /J,,,
EXISTING BUILDING
27 -
c I c! "' //4
LATERAL LOCATION
ST.
LATERAL NO. _______ INSTALLATION DATE--------1
~t'l>,I
~ ISSUED
VALIDATION
,J(/ L. ~-
BUILDING DEPT.
_)
LATERAL CHARGE COMPUTATION
OVER 30' H. @ FT. _________ _
OVER 10' V. ___ @ ___ FT. _________ _
STANOARO 6" (Max. H. 30', V. 10') _________ _
OVER 30' H. ___ @, ___ 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---TOTAL---
PUMP STATION FEES
NO. UNITS ___ COST PER UNIT ___ TOTAL---