HomeMy Public PortalAbout9560 BISBY ST_Sewer__ ]DRPAh'J2dlnW OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGET,
WILLIAM J. FOX. COUNTY ENGINEER I BUILDING ;
ADDRESS ]J.
FOR APPLICANT TO FILL IN LOCALITY—___T_ ,
BUILDINGNEAREST
ADORE 88 t NOSS ST.
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO. C
NEAREST i�Y A - �� �S
CROSS 8T. c—
(/
OEIVED BY Ready for Imap"vo■ DATE ISSUED
OWNER AIL �— —
ADDRESS r Y�(� USE Z E OCCUPANCY MAP
BK PQ
CITY TEL-NO. —l —
CONTRACTOR G� l G O� CO.IMP.NO.
ADDRESS
G JOB N0. �
CITY TEL-110. TRUNK PERMIT NO.
AYE
REGISTRATION NO. 2 COUNTY ROAD PERMIT NO. �G
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT / g 'f INDUSTRIAL
+ ! WASTE APPROVAL
NOW ON LOT
SIZE OF LOT G O /J} MO.OF BLDG& CHARGES
J
UBE OF r
CONNE CHARGE FEE
BUILDINGS
NO. DESCRIPTION O WORK FEfE REIMBURSEMENT
OUSE SEWER CONNECTING TO
PUBLIOSEWER Q $ L50 � REOEIPTNO. T[ BY
SEWERHOUSE DON ING TO
PRIVATE DISPOSAL SYSTEM 1.10
NMADDITIONAL B S-09 EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR PA NO- DATE BY T
SEWER OR DISPOSAL SYSTEM IAO
DISCONNECT AND ABANDON SLrWEB
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
PITS AND/NkOR DRAINFIELD OR/OR
2.00 STATION DEPTH
CklWtPOOL--DRYWKLL I _
SPECIAL CONDITIONS ONLY 2.08 11 M N's V �HGL RgFERENOE LOW
TYPE I� ECTION LENGTH FROM 1
OWNERS PERMIT. $ I 00 OUR 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 D T F 19— NEW HOUSE SEWER
OWNER oR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIO TANK SEEP.PIT(S)
ADDRESS C' AND/OR DRA NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI APPLI- CESSPOOL I] DRYWELL I]
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS. BEWAdE DISPAl L SYSTEM
I HEREBY OERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF RNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ESCBIB SIDE T ROPERTY. BACKFILL 5FPTIO TANKS❑
li
SIGNATUR S[EP.PIT(S)E] CESSPOOLS
r t.
OF PERMITT7<
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