HomeMy Public PortalAbout5482 BARELA AVE_Sewer__ DFPA$TMENT OF OOIINTY EN(flavEER SEWER-SEW E�
DMSION OF EIMMING AND SAFETY PERMIT APPLI TION
COIINTY OF IAS ANGRY
WILLIAM J. FOX, COUNTY ENOINLKR BUILDING
ADDRESS
FOR APPIJ T-TO RLL I LOCALITY ti
BUILDING �J NEAREST
ADDRESS CROSS ST. �� #
LODALr Y DISTRI - ry0. A SERIAL NO. ]l�J PERMIT Y0. c
NEAREST rY A • '�^6 J
CFt088 BT.
,RECEIVED OY Rsady for IuFKUe■ DATE IESU D
OWNER Y �CG}7 ���� J•
MAILUSS ZONE OCCUPANCY BK YAP
ADOBE'Sb
pe
CITY TELNO. —
CONTRACTOR o� CO.IMP.N(L f
ADDRESS JOB.N0.
CITY 96,23 TELNO. TRUNK PERMIT 3 NO-
TE /
REGISTRATION Np0�� DOUNTY ROAD PERMIT N0.
DE8CRLEG�IPTIO 'ZOT Q� STATE ENCROACHMENT 5 `
PERMIT N0.
BLOCK TRACT — 37 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT7Q NOW ON LOTS / CHAR 8
BLD
USE
BUILDINGS ' A CONNECTION CHARGE FEE }
.i[./'t.�
NO- DESCRIPTION OF WORK FLE REIMBURSEMENT FEE-HOUSEr;
PUBLIC SEWER NQ &H RECEIFTNO. DAT t BY
HOU SEWN COY NG
PRIVATE DISP08,AL SYSTEM I.W
UNNECT AL RLDG.OR EXOEPTION E008 1 D
WORK TO HOUSE SEWER 1.09 N0.
ALTER OR P EXISTING
SEWER OR DISPOSAL SYSTEM I." D
DISCONNECT AND ARANDOld SEWER
AND OR DISPOSAL SYSTEM 1.00 1 COONNNECTIO D /a
EPIT NK-SEEPAGE PIT
PITS AND/OR
DRAI
NFIIELD OR 2.00 STATION ,> , DItPTH S
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2-W ' MANHOLE REFER YCfi
0,09 -tflizER d LOWER
TY F NB-NEOTION _ LENGTH F r
Y.
OWNERS PERMR $F I 00 MA-TO P.II. L)'
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE Do1fTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO SIGNATURE DAT
DWELLING TO THE PUBLIO SEWER
SIGNED THIS DAY OF Iq_ NEM HOUSE SEWER
OWNER OR OONNECTADDITIONAL S
OWNERS AGENT BUILDING OR WORK
8EPTIO TANK SEEP.PIT(S)
ADDRESS AND/OR DRA NFIELD
1 HEREBY AOKN0WLEDGRTHAT 1 HAVE READ THIS APPLI- CESSPOOL El ORYWELL -
CATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCI B AND STATE LAWS ALTERR,REPAIR,SEWER OR
REGULATING PLUYBINO AND SEWERS. SEWA9E DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED lf AND
LUG
AND/OR LICENSED AS REQUIRED BY L0S ANGELES COUNTY ABANDON DISCONNECT HOPLUG ANDR
AND STATE OF CALIFORNIA OR THAT I ATHE LEGAL OWN-
ER OF THE ABOVE DESCBIBED RESIDENTIAL PRO ERTY. N n i
SIGNATURE SEEP.PfT(S)E] CESSPOOL.BE]
OF PERMITTEE
TGAU2A 063 1/63