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APPLICATION FOR PEAMTT
DEPARTMENT OFNG AND SAFETY PLUMBING 1
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEF ENOIN[ER
DISTRICT NO. Nu.
FOR APPLICANT TO FILL IN -,�// [37PI Au / i
PLUMMER f%$14ee,44t, JS REC[ *XADY,FOR DATE ED
FIR!'T INI PEEITION - C/
ADDRESS
/ SUILDIN
CITY TIL No. ADDR[l■
130UNTY LOCALITY
LKrlRrA N EAR EST
ERb�.p��J.L le�
PFEES C R OM OT.
Hum"" TYPE of FIXTURE OR fT[M F[[ OWNER
MAIL
ATTR CLO0[T(TOILET) ! 0.50 • ADDRESS
OATH TUB ! 0.60 CITY 1 TIL No.
SHOWER ! 0.513 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIN
LAVATORY (WASH SARIN) O 0.50 APPLICATION AND (TATE THAT TH[ ABOVE 10 CORRECT
AND A13RM TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK ! 0.513 AND STATIC LAWN REGULATING PLUMBING.
I CERTIFY THAT 1 P13138E1■ THE ABOVE VALID LOB
LAUNDRY TUB R TRAY ! C.So ANO[LXE COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RJ[11DENTI PROPERTY D RIS OV[.
DAB WYST[ UTLETo ! 0.613
■IONATURK OF
WATER HEAT[ ! 0.813 P[RMITTi, -�
■LOP OINK ! 0.80 INSPECTION RECORD
i
FLOOR IMINK ! ELSE)
FLOOR DRAIN ! 0.50
DISHWASHER ! 0.80
DRINKING FOUKTAIN ! 0.513
URINAL ! 'CLOD -1
t
HOUSE NEWER ! EL50 Z
MINOELLAN[OUS 0
D
APPROVALS
DAT[ IM/rtOTOR'■ NAME
ROUGH PLUMSINO �y /-41 ✓A /� S
OAS PIPING
OAS V[NT
OEBBPOOL ! 1.00 CESSPOOL
DEP-1-113 TANKI SEPTIC TANK '
DRAIN ( ) PIT ( ) ! 1.00 SEWER
PERMIT I t.E)13 MAN TEOT
UTILIT'O0.NOTIFIED
TOTAL FEE ■