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D B 17 25M BETS is 43 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY �� R 1
COUNTY OF LOS ANGELESALM
Wm J FOX CHIEF ENGINEER
mB
NATURE OF INSTALLATION DISTRICT No GROUP ZONE PERMIT NO
ROUGH FIXTURES COMPLETE �
RECEIVED BY READY FOR DATE ISSUED
NEATER CESSPOOL SEPTIC TANK FIRST INSPECTION DA `
AS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
E NAME / ADDRESS
B ADDRESS Q� LOCALITY nil _ ,
NEAREST
u
G CITY 1� �/'� TEL No CROSS ST /
COUNTY dYD 11
CERT NO EXPIRESW NAME I
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL n
' 3 ADDRESS
NORTH O
Cl �� TEL No
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION
PLUMBER
I AM THE LEGAL OWNOF O TROPE TY DESCRIBBD
ABOVE
s �
,= Y1 OWNER
-1 CORRECTIONS
SOUTH J
DESCRIPTION OF WORK i
BATH TUB FURNACE m
IC
-SHOWER DISHWASHER O
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
L__J�wcl
LOOR SINK SAND TRAP
OP SINK FLOOR DRAIN
ASH TRAY URINAL APPROVALS
ATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR a NAME
ATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I
METER-GAS �+DA FOUNTAIN GAG PIPING I I
OUTL
GAS VENT
CESSPOOL
OTAL NUMBER OF FIXTURES SEPTIC TANK I I
SSPOOI SEPTIC TANK ! SEWER
$ UTILITY CO NOTIFIED
TOTAL FEE C �G
FINAL