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HomeMy Public PortalAbout9527 BLACKLEY ST_Sewer__ NWAaEP ARTHENT OF OOUNT'Y ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGEIES BUILDING WILLIAM J. FOX, COUNTY ENo1Nea1: I_ADDRESS cl 5 , 7 ���a—���el=k' FOR APPLICANT TO •FILL IN LOCALITY BUILDING _47 NEAREST ADDRESS9 � ,Ic CROSS ST. LOCALITY 'I"e^112 Df8T�CT N0. Ready for Inspection- PERMIT N0. % C,' ��., . Com► /, r6. s NEAREST �� ROSS ST. CQ(I gr 4/ �� r EC LVED BY DATE 1 UED BY l DATE y. ® OWNER �MAILI�^Q. �rj�/B l// ADDRESS g�J a����(� _/�IC�GfC�d?(! r,USE ZONE OCCUPANCY BK PO MAP CITY e), /L, L.TLI TELAO. ..�,0.3Q � � I (/�8/® /% IV CONTRACTOR ©GIT pj ed~ CO.IMP.NO. ADDRESS JOB NO. -�- CITY TEL.NO. TRUNK PERMIT NO. STATE REGISTRATION NO. COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. �OO�(�/ •%�1 �� i STATE ENCROACHMENT ►� I (? T J _\ 1 PERMIT N0. BLOCK TRACT A4 / 2 /� O 'INDUSTRIAL WASTE APPROVAL SIZE OF LOTNO.OF BLDGS. Z�NOW ON LOT CHARGES USOF BUE DINGS S . 4- (r'-a -y/d q) CONNECTI HARGE FEE NO. DESCRIPTION OF WORK FEE' HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER @ $ 3.50RECEIPT NO. II_BY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDO.OR EXCEPTION RECORDED WORKTO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING '`I DATE I BY _ SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM 1.00 / �=� CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR „� PITS AND/OR DRAINFIELD 2.00 STATIONS DEPTH CESSPOOL—DRYW ELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER 'a1xG�` 'L LOWER TYPE OF CONNECTIONL•ENd H FROMc"_+.�� OWNERS PERMIT $ I 00 Y. CURB - P.L.�*""M.L.TO P.L. �s AUTHORIZATION TOTAL FEE 21/77,7 I � 1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGgppROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED CHIS DAY OF 19_.. NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT.•...-.-.___ _ 'BUILDING OR WORK ADDRESS.-.-..-__.._.._._ SEPTIC TANK,SEEP.PIT(S) -------- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- ';CESSPOOL[][] DRYWELL CA NON 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 I AM PROPERLY REGISTERED ASID/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY 1 DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT i AM THE LEGAL OWN- IABANDON HOUSE SEWER ER OF THE ABOVE DE RIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIO NATURE n r,I ' �SEEP.PIT(S)E] CESSPOOLS 0 OF PERMITTEE-_-._.�.- 76AG42D S&E 663 4/54