HomeMy Public PortalAbout9020 ACASO DR_Sewer_1/29/1953_1744-S sewer connection DEPAP-lm •*w OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
..vEyPIVISION OF BUILDING AND SAFETY
PERMIT APPLICATION
COUNTY OF LOS ANGELES ;
WILLIAM J. FOX, COUNTY-ENGINEER BUILDING]
CASSATT D GRIFFIN, SUPT OF 13UILDINO ADDRESS V !
fqR APP�JICAIJT/j�TO FILL IN , LOCALITY -7--_�,,I,I,,rABUILDIN ,�,l„
1i o,ADDRESS �U �'+� �/ �T-� NEAREST�K•.�.. CROSS ST
LOCALITY �7 f��l` ( DISTRICT NO V SERIAL No PERMIT NO S-
CR C" 7L Ay g 1 -� ,
CROSS ST C_
/� RECEIVED BY Ready for Inspection DATEISSUED
OWNER J 0 /7'�.-s 23' ('Q.6LA - -% sa
MAILADDRESS V .O �`!-,S Z? •C.
USE ZONC OCCUPANCY B MAP G
CITY i-� TEL NO �'
CONTRACTOR IrD 2 D CHARGES _ ;REI BURSEMENT FEE
ADDRESS SL 3`,(fr 4 REQUIRED`
CITY A ( �O',) /f,¢ TEL N p_ )-3 )3.(- NOT REQU_Ui
',/ �O ICON/NECxfGN CHARDE F`E ,
REGISTRATION NO 116 mud COU.NW-Yi I CO IMP NO
LEGAL �J -, �q •�/ �/ °` RECEIPT NO DATE BY
DESCRIPTION LOT N0 , �r[ �w7 � ✓�G' 404 ,.,....�-- Y
BLOcvTRACT `S i=.Im�•� f Oft 5_9c WAIVER FOR RECORDING �
NO OF BLDGS / �{
SIZE OF LOT NOW ON LOT ( •P RECE PT NO _e `� I/DATES I BY-
USE
BUILDINGS NGS
NO DESCRIPTION OF,WORK FEE TRUNK PERMIT NO
i. HOUSE SEWER CONNECTING TO - .L�' ROAD PERMIT NO ~
PUBLIC SEWER 0 $ 350 V
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1 00 PERMIT NO •gyp
CONNECT ADDITIONAL BLDG OR INDUSTRIAL—
WORK TO HOUSE SEWER 1 00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 STATION . v DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 20
0
00 MANHOLE k9FERENCE
CESSPOOL—DRYWELL I UPPER OIKGR•
SPECIAL CONDITIONS ONLY 200 TYPE OF CONNECTI N LENGTH FROM
Y, GYAB— _aj_ ML TOP L
OWNERS PERMIT I 00
AUTHORIZATION TOTAL FEE 'p
I 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 - Iq - NEW HOUSE SEWER
OWNER OR k$ CONNECT ADDITIONAL WORK
OWNERS AGENMA `
ADDRESS Ir A ) SEPTIC TANK SEEP PIT(S)
"{�� h. AND/OR DRAINFIELD
-
1 HEREBY ACKNOWLEDGE THr I HAVE READ THIS APPLI- CESSPOOL E] 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 4s''
AND/OR LICENSED AS REQUIRED BY LOS ANGELES=COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR-THAT I AM THE LEGAL OWN-
ER OF THE ABOVE
\D/ RIBED VSI NTIALl PROPERTY BACKFILL SEPTIC TANKS �-
SIGNATURE SEEP PIT(S)[] CESSPOOLS
OF PERMITTEE r [[ V►r
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