HomeMy Public PortalAbout9084 ACASO DR_Sewer_1/28/1953_1902 S DEPARTMENT OF COUNTY ENGIIVEM SEWER—SEWAGE DISPOSAL• 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
UILDING
WILLIAM J FOX. COUNTY ENGINEER ADDRESS 9D�� C��O A0,07CABBATT D GRIFFIN T F BuPOBUILDING
FOR APPLICANT TO FILL IN LOCALITY `O WL,
DSS OSTADREFOM 4. / �.*So oe NEAREST
RSS -# c O
DISTRICT NO SERIAL d PERMIT NO
LOCALITY TS N/pL E CtTv�- ��� � .�+ A S'3 9d Z S
NEAREST 5A=_ PE"0 be,
CROSS S7 ,] y ) RECE/I�V D BY Ready for Inspection DATE ISSUED
OWNER W'11- F tA4tV.6 �tJ,/p� L.. V C /Ll /— 2 p-.T3
MAIL ADDRESS 9B8 T �. /9`/q g �i�, USE ZONE OCCUPANCYe BK MAP PG
CITY �C: IbL 4� C ��TEL NO T I �G S
A
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS REQUIRED
NOT REQUIRED------------�
CITY TEL NO
i JOB NO ..►��� CONNECTIOCHARGE FEE
STATE i CO IMP NO
REGISTRATION NO COUNTY
DESCRIPTION LOT NO 041y /P
93' lY �0�84 °�' � RECEIPT NO�_I DATE - B
BLOCK TRACT RS eg-m--/9 f WAIVER FOR RECORDING
SIZE OF LOT GI L/ I Y('03;! NNOOWOOF NLOBLDT OC
GS h RECEIPT NO,�.,..I.e.+ DATE BY
USE OF A0,e5/DENLI E
BUILDINGS TRUNK PERMIT NO
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ROAD PERMIT NO ;2.2 gg 74/
PUBLIC SEWER Q $ 350
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
f PRIVATE DISPOSAL SYSTEM 100 } PERMIT NO
CONNECT ADDITIONAL BLDG OR INDUSTRIAL
WORK TO HOUSE SEWER 1 00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 n,� LCONN.ECTION DATA
DISCONNECT AND ABANDON SEWER / --
AND/OR DISPOSAL SYSTEM 1 00 STATION,. vL r&' DEPTH
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 I MANHOL FJ EXVJ ,Rj s
CESSPOOL—DRYWELL UPPER L0 r Ar
SPECIAL CONDITIONS ONLY 200 I TYPE OF CONNECT ON LENGTH FROM
CURB -Pet_ ML TO P L /
OWNERS PERMIT $ I I 00 —
AUTHORIZATION TOTAL FEE I ;, 0-6,
1HAVE 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 y ,Z-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ BUILDING OR WORK
SEPTIC TANK,SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 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 REPAIRSEWER
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
SIGNATURE �J� �I-0, �y/ SEEP PITS)E] CESSPOOLS E]
OF PERMITTEE M1� Qf I -"'�
76A642D 663 12/52