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D B 17 25M SETS 12 43 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES
Wm J FOX CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT GROUP ZONE PERMIT
ROUGH FIXTURES b COMPLETE �� / G
RECEIVED BY READY FOR DATE ISSUED
HEATER CESSPOOL � SEPTIC TANK 1 i FIRST INSPECTION
AS MISCELLANEOU
_ APPLICANT FILL IN HEAVILY OUTLINED PORTr\ION/ONLY
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g NAME /_/gAo ADDRESS / �J ♦ !A�i,�7
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CERT No /�0,3'- /�� EXPIRES30MA/16 Z NAMEI III
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LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS
NORTH O
CITY TEL N
1 AM THE LEGAL"P0�8689 cOFe4HE ABOVE LOS
ANGELES COUNTY CE T FIC flOF QUALIFICATION
PLUMBER
I Al THE LEGAL OWNER OF THE PROPERTY DESCRIBED
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1
OWNER
CORRECTIONS
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SOUTH
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DESCRIPTION OF WORK a
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HATH TUB FURNACE �_
HOWER DISHWASHER
AVATORY REFRIGERATOR a
i
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR B NAME
WATER HEATER - DENTAL LAVATORY ROUGH PLUMBING I I
® METER�,GAn SODA FOUNTAIN lvvv
6A8 PIPING
GAS VENT
CESSPOOL
TOTAL NUMBER OF FIXTURES _ Q Q SEPTIC TANK
CESSPOOI SEPTIC TANK a SEWER
S
TOTAL FEE UTILITY CO NOTIFIED I
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FINAL