HomeMy Public PortalAbout9926 MILOANN ST_Sewer_3/11/1953_CONNECT ADTL BLDG TO HOUSE SEWER 7JEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
I$IVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ADILDING
DRESS
FOR ,APPLICANT TO FILL IN NEA rES
BUILDING 1 'p
NEAREST
ADDRESS J '�r S .r � , ° ST.
LOCALITY ~9' LG t + SERIAL NO. PERMIT NO.
NEAREST a' Z
CROSSST }d lt,¢L�.L—�- -•
Ready for Inspection f DATE ISSUED
OWNER
MAIL r rr OCCUPANCY MAP
ADDRESS E ,�1-CITY TELAO. I BK PG f,
CONTRACTOR /
CO.IMP.NO.
ADDRESS
JOB.NO.
CITY TEL.NO. TRUNK PERMIT NO.
(] STATE
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO.
LEGAL ;3 '
DESCRIPTION LOT N0. h STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT: 1 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT' ? r NO.OF BLOCS.
NOW ON LOT '" >".. CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 i RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO. DATE ALTER OR REPAIR EXISTING BY
SEWER OR DISPOSAL SYSTEM 1.00
N
DISCONECT AND ABANDON SEWER C CONNECTION DATA
ANOJOR DISPOSAL SYSTEM 1.00
SEPTlC TANK,SEEPAGE PIT OR
PITS ANO OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
f TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
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._._1' �.._... DAY OF. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN d>(wr� t BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS _.
-' ' ��'�-�y-�-�'-��-•••��;i'-4 AND/ORAINFIELD
f HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL[:] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE,
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
SEWER
ER OF THE ABOVE DESCRIBED RESIDENAL PROPERTY. BACKF►LL SEPTIC TANKS
RESIDENT
AL
r 1J SEEP.PIT(S)[] CESSPOOLS
OF PERMITTE _-.-
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