HomeMy WebLinkAbout1511 BASSWOOD AVE; ; SE679888; Permit/r/\ // .3XJ Vm/ LEGAL BUILDING DESCRIPTION LOT NO. ADDRESS
NEAREST . CROSS ST. I
OWNER PP
MAIL ADDRESS
CITY TEL. NO.
. +
CONTRACTOR'S STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO.
OWNER'S
AUTHORIZATION
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 READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
ERN. SIGNATURE
CONNECTION DATA Lateral Charge Computation
30' H., IO' V. @ 4" = - 6" = -
Add. Horiz. @ 4" = - bH = -
Add. Vert. @ 4" = - 6" = -
Total Construcfion 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. @- / dwelling
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
st. NORTH
ENGINEERING SEWER DEPT.
Signed I Signed
/ h 4 Serery When Properly Filled Out, Signed and Validated
Issued By
PERMIT VALIDATION
5% 75- BUILDING DEPARTMENT
APPROVALS DATE
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
PLUMBING FIXTURES
MISC.
MAII Y -
INSPECTOR'S SIGNATURE
.. . . . . - ADDRESS - J / 1
I- -
GRADING PLAN
NoO YES 0
- STATE CARLSBAD BOSINESS
ITEM
?3'3i, -L
NO. 1 L! TOILET
PERMIT
TOTAL FEE $
SHOWER 8 1.25
WASH BASIN 0 1.25
c-
KITCHEN SINK
DISHWASHER 1.25
LAUNDRY TUB OR TRAY 1.25
AUTOMATIC WASHER 1.23
WATER HEATER & VENT 8 1.50 jw
GAS SYSTEM 1 TO 15 ;/
t .30 LA. ADD. @ 1.50
FLOOR DRAIN OR SINK
LAWN SPRINKLER
MISC. WATER PIPING
GARBAGE DISPOSAL
VACUUM BREAKER OR BACK
PERMIT - APPLICATION
CROSS ST.
GROUP I ZONE
Inspection Record
1 CERTIFY THAT I AM PROPERLY REGISTERED AND LI-
SIGNATURE OF PERMITTEE
VALIDATION erly Filled Out, Signed and Validated. d within 60 days of date of issuance.
UTILITY CO. NOTIFIED
FINAL