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�,,..,... APPLICATION FOR PERMIT
COUN" OF LOS MUM SEWER—SEWAGE DISPOSAL
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HOUSE SEWER CORRECTING TO P.C.No.
PYIYATH DISPOSAL SYSTEM 1.00 CO.IMP.110 JOB 110.
CONNECT ADDITIONAL BLDG.OR TYORK PERM-IT R0. ROAD PERMIT R0. ..
AWORK TO HOUSE SRE�t 1.00
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I HATE AT THIS DAT= A CONTRACTWITH TH7< HEREIN RAMED CON- gOV DATI( 1NBPECTOR'8II1faRATUiLE
TRACTOR TO CONNECT THE ABOYB bBSCYIBED BUSTING DWELuna
To THE Fn u c
SIGHED THIS nAy OF 12:9 NEW HOUSE SEWER
OWRIY ORCL CONNECT ADDITIONAL
OWREYf A BUILDING OR WORK
DEPTIC TANK,STEP,PIT(d)
ADb AND OR DRAIRFIEL.D
1 HEREBT ACKNOTLEDGM THAT I SAYE READ lqrls APPLICATION
AND STATE TRAT TRE /I�DDOTE ID COGAEC'� AND AGREE TO CORPLT CESSWOL DRTWELL
WITT) ALL COUNTT ORDINAACES AN-O IYl U LAWS REGULJTINGALT 2 REPAIR,SEWER OR
PLUMBING ARP SEWERS. SEMIAGB DISPOSAL STSTEM
[ HEREBT CERTIFT THAT I AM PROPERLT REST A OR DISCONNECT PLUG AItD
LYCENYED UIRED HT D ELES OU OF ABANDON HOUSES WER
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