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D B S 17 zaM SLTS iz 41 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING
WM J FOX CHIEF ENGINEER
NATURE OF INSTALLATION DISTRIC O GROUP ZONE PERMIT
'y/NO
ROUGH FIXTURES COMPLETE , V //
E EIVHD BY READY FOR DAT ISSUE
HEATER CESSPOOL 1-1 SEPTIC TANK FIRST INSPECTION jE
GAS MISCELLANEOUS "' /T7
APPLICANT FILL,IN HEAVILY OUTLINED PORTION ONLY
NAME q ��f JOB
K .� �VtVo'�"� ADDRESS
W
m ADDRESS LOCALITY
NEAREST
J
CITY TEL No CRO 68 BT
COUNTY
CERT No EXPIRES NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
ADDRESS
NORTH 0
CITY TEL No
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFIC F 0 ALIFICA4jV,0N
PLUMBER
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIDTD
ABOVE
A
D
3 ® OWNER
CORRECTIONS
SOUTH
DESCRIPTION OF WORK
ATH TUB
FURNACE
Nr
--SHOWER DISHWASHER a+
O
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK _SAND TRAP
LOP BINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR 6 NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
METER GAB _SODA FOUNTAIN
OUTL GAS PIPING `
GAS VENT I I'
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOI.__SBEPTIC TANK
L__/_ SEWER
S
I
TOTAL FEE r - UTILITY CO NOTIFIED
FINAL