HomeMy Public PortalAbout9078 ACASO DR_Sewer_4/3/1953_5876 S connect to public sewer DEPARTMENT OF COUNTY ENGINEER I SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS 7 0,f_ '
( GIj/
LOCALITY '
i� FOR APPLIC NT TO FILL IN
BUILDING Y ��J , NEAREST
ADDRESS 9 CROSS ST
LOCALITY'722_ 4:2, '�` DISTRICT NO D SERIAL NO PERMIT NO
NEAREST ` AS
CROSS �q� �p S
CR08S ST C
REC/EIV,EGD BY/� Ready for Inspection DATE ISSUED
OWNERMAIL
4� ADDRESS �^ U8E ZUNE OCCUPANCY MAP
BGS.
CITY C � TEL NO
CONTRACTOR
` CO.IMP NO 1J 7� ^'3
ADDRESS �� Q Tom/-/ JOB NO 1
CITY 46"Jj TEL NO& TRUNK PERMIT NO
REGISTRATION NO 1-46 AK ROAD PERMIT NOAm X—S
LEGAL ('1 /j
DESCRIPTION LOT NO STATE ENCROACHMENT
,.. y PERMIT NO
BLOCK TRACT i INDUSTRIAL
SIZE OF LOT
/.�iJ X l v�NO OF BLOBS WASTE APPROVAL ,
NOW ON LOT CHARGES
USE OF
BUILDIgGS t//eIII CONNECTION CHARGE FEE '
NO DESCRIPTION OF WO K FEE
J HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE x
/ PUBLIC SEWER $ 350 RECEIPT NO / DAT`E I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONWORKTO ADDITIONAL
SEWERLDO OR 1 00 /EXCEPTION RECORDED
ALTER OR REPAIR EXISTING f NOI DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 200 STATION')-/, T / 1 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 ' � ANH LEREFERENCE 4 �L0f--
` UPPER
OWER
TYPE OF CONNECTION I ENGTH FROM
OWNERS PERMIT ; 1 00 Y� CURB %.P.L.. ML TOP L
AUTHORIZATION TOTAL FEE ygti
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'BSIGNATURE DATE
DWELLING TO TN PUBLIC SEWER
SIGNED THIS DAY OF ._. � ! _19_ NEW HOUSE SEWER
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT. _ _ _ BUILDING OR WORK
ADDRESS _ _ _ - AEPTIC TANK SEEP ND/OR DRAINFIELPIT(S)
D
1 HEREBY ACKNOWLEDGE THAT I HAVE READ IS AP L-1— SPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRE ND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AN TATE LAWS ALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LIC D AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STAT OF LIFORNIA OR THAT i AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OFT E AB9PE DESCRIBEDESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
81GNAT01
SEEP PIT(S)� CESSPOOLS
OF PM _ _ER
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