HomeMy WebLinkAbout1695 BASSWOOD AVE; ; SE669486; PermitCITY OF CAtRlSBAO
BUILDING DEPARTMENT
FOR APPLICANT TO FILL IN
AUTHORIZATION
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD- ING TO THE PUBLIC SEWER.
SIGNED THIS OWNER OR OWNER'S AGENT
ADDRESS
I HEREBY 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 AND SEWERS. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
rly Filled Out, Signed and Validated
CONNECTION DATA Lateral Charge Cornpubtion
30' H., IO' V. @ 4" = __ 6" = -
Add. Horir. @ 4" = __ 6" = -
Add. Vert. @ 4" = - b" = -
Total Construction Cost
10% Service Charge
Total Lateral Charge
Lat. No.: Logged in Plaf:
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
ENGlNEERf NG SEWER DEPT.
Signed 1 Signed
Issued By .. . PERMIT VALIDATION
CITY ;OB: cARmAD
7,
- 3
1
1
/
/
BUILDING DEPARTMENT
TO I LET $1.25-2
WASH BASIN 8 1.25 7 .
BATH TUB 8 1.25 A
SHOWER Q 1.25
KITCHEN SINK @ 1.28 /
DISHWASHER 0 1.25 /
LAUNDRY TUB OR TRAY @ 1.25
AUTOMATIC WASHER @ 1.25
WATER HEATER & VENT @ 1.50
GAS SYSTEM I TO IS .SO EA. ADD. @ 1.50
FLOOR DRAIN OR SINK @ 1.25 __
LAWN SPRINKLER 8 2.00 __
MISC. WATER PIPING @ 1.50 __
1 I OWNER . ep
MAIL ADDRESS _.
Y
/ / I
STATE CARLSBAD BUSINESS LICENSE NO. LICENSE NO. 6'2 67
ITEM IF ZOf3oZ
NO I
GARBAGE DISPOSAL
VACUUM BREAKER OR BACK
GRADING PLAN PERMIT
YES 0
00 e
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 1 CENSED AS REQUIR STATE OF CALIFORNIA OF THE ABOVE DESC
SIGNATURE OF PERMI
PERMIT - APPLICATION
BU I LDI NO
NEAREST f CROSS ST.
, ADDRESS
I I ZONE GROUP Inseection Record
APPROVALS 1 DATE 1 INSPECTOR'S SIGNATURE
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
PLUMBING FIXTURES
MISC.
GAS TEST
UTILITY CO. NOTIFIED
JTTNAL I I
ALIDATION ' This is humbing Permit When Properly Filled Out, Signed and Va
Permit void if work is not commenced within 60 days of date of iss!%:'