HomeMy Public PortalAbout9084 ACASO DR_Sewer_1/28/1953_1901 (3) DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER BUILDING �0� r a as
�D D).CASSATT D GRIFFIN Dc SuP-T BUILDING I ADDRESS �/�(�^
FOR APPLICANT TO FILL IN y LOCALITY %,,q/e C '
/BUILDING NEAREST
ADDRESS 9v ¢ e . oet gse CROSS ST s
p1 /� DISTRICT NO SERIAL NO PERMIT NO
LOCALITY TE/'! L CIT L" Y( t A S-.3 f J /2D/ S4
CROSS ST �A`� ` a N,) D >�• / ` /• I RECEIVED BY Ready for Inspection f D`ATT^E I�SSSUED
OWNER YV O R 7Av loR /4 o Al A II. • I Cl-�S /p d�°V
ADDRESS 9MAIL 0�� /E /4e_IgSc Ax. USE ZONE OCCUPANCY
� BK MAP PG
CITY 7'&7MA � �� -TEL NO fr ,d� ' G s
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS REQUIRED
NOT REQUIRED�"��'
CITY TEL NO JOB NO f' CONNECTION CHARGE FEE
STATE
REGISTRATION NO COUNTY
LEGALfr�� �� I �/V �A ti RECEIPT NO DATE I BY
DESCRIPTION LOT NO J'-'! QL 7'
BLOCK TRACTr+s s *40 IF MOC6 ,S+� WAIVER FOR RECORDING
SIZE OF LOT��,4/ YNO OF.J NOW ON LOTS �. RECEIPT ----DATE, BY ^'-•
USE OF
BUILDINGS /rte$%!!B/ �`,!$ TRUNK PERMIT NO _----•-
NO DESCRIPTION OF WORK FEE
iHOUSE SEWER CONNECTING TO - ROAD PERMIT NO �®
PUBLIC SEWER @ f 350 I 3 so
`I HOUSE SEWER CONNECTING TO PSTATE ERMIT NCROACHMENT
PRIVATE DISPOSAL SYSTEM 100
CONNECT•ADDITIONAL BLDG OR X INDUSTRIAL
WORK TO HOUSE SEWER 1 00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
` SEWER OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER ,•
AND/OR,DISPOSAL SYSTEM 1 00 I STATION DEPTH
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 I MANHOLE FE E E � vJw*Ai'
SPECIALCONDITIONSD LONLY 200 I - _UPPER W/ �V-E - '
TYPE OF CONNECTION LENGTH FROM / //
CURB .RA— ML TOP L
OWNERS PERMIT I 1 00 -
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT(I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURESEEP PIT(S)o CESSPOOLS
OF PERMITTEE j0P52AJVLW
BEIMI
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