HomeMy WebLinkAbout1635 BASSWOOD AVE; ; SE669482; PermitCITY OF UUWM
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 $3.00
SEPTIC TANK, SEEPAGE PIT OR PITS @ $5.00
OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.,
CESSPOOL, DRYWELL. MANHOLE 0 $5.00
HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 0 $1.50
CONNECT ADDITIONAL BLDG. OR
ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $2.00
WORK TO HOUSE SEWER 8 $1.50
BUILDING DEPARTMENT
7 P
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION LOT NO.
CONTRACTOR'S STATE CARLSBAD BUSINESS
LICENSE NO. LICENSE NO. -
OWNER'S I PERMIT $1 ,: lg
AUTHORIZATION TOTAL FEE
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 RmD THlS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
BUILDING ADDRESS
NEAREST / CROSS -sr.
MAIL ADDRESS
A I.
CONNECTION DATA Lateral Charge Computation
30' H., 10' V. @ 4" = ___. 6" = ___
Add. Horiz. @ 4" = - b" = -
Add. Vert. d 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. S. @- / dwelling
OTHER
TOTAL
Grand Total, Lateral, etc.
FOR SEWER LOCATION
v) ij
st. ' NORTH
ENGINEERING SEWER DEPT.
signed I Signed -... .. SIGNATURE
rly Filled Out, Signed and Validated / luurd By
PERMIT VALIDATION
BUILDING DEPARTMENT
x.
-- 3
1 I 1 r
n /!!Q /’p /
TOILET 8 51.25 2
BATH TUB 8 1.25
SHOWER 8 1.25
c WASH BASIN @ 1.28
KITCHEN SINK @ 1.28 \
DISHWASHER @ 1.25 /
LAUNDRY TUB OR TRAY 0 1.25
OWNER /5//
MAIL ADDRESS
-
STATE CARLSBAD BUS1 NESS LICENSE NO. LICENSE NO.
1 WATER HEATER & VENT 8 1.50 2 I .so EA. ADD. @ 1.50 1 GAS SYSTEM I TO 15
FLOOR DRAIN OR SINK
LAWN SPRINKLER
MISC. WATER PIPING
2.00
1.50
__
-
! GARBAGE DISPOSAL
VACUUM BREAKER OR BACK -I -- FLOW DEVICES 1 TO 5 @ 200
I
GRADING PLAN I PERMIT s
YES 0 I TOTALFEE SI/%
- E - Jt y”
7)c
2) 2)
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.
1 CERTIFY THAT I AM PROPERLY REGISTERED AND II-
M THE LEGAL OWNER OF THE ABOVE DESC
PERMIT - APPLlCATlON fJ&?
BUILDING rc
ADDRESS 3 NEAREST ‘ CROSS ST.
I
GROUP I ZONE
Inmection Record
APPROVALS I DATE I INSPECTOR’S SIGNATURE
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
PLUMBING FIXTURES
MI SC.
~
UTILITY CO. NOTIFIED
FINAL
1 ’& a PiumbingLWhen VALIDATION Properly Filled Out, Signed and validated.
Permit void if wo is not commenced within 60 days of date of issuance.