HomeMy Public PortalAbout9108 DUFFY ST_Sewer__ DEFARTBIENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY - PERMIT APPLICATION
COUNTY OF LOS ANGELES O
WILLIAM J. FCX. COUNTY ENGINEER BUILDING (% '/
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//FO�� R APPLICANT
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ADDRESS c�J/Q .y /rJ( - CROSSST. Q�G
DISTRICT NO. SERIAL N0. PERMIT N0
LOCALITY .
NEAREST
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CITY Jy/�.(� TEL.NO.�jI�'� 64� TRUNK PERMIT NO.
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REGISTRATION NO. V ['-G -� OUNTY ROAD PERMIT NO.
LEGAL f STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT N0.
BLOCK TRACT // //Gj INDUSTRIAL
[CYC' WASTE APPROVAL
SIZE OF LOT 5—OX��I� NOW ON LOTS / CHARG
BUILDINGS USE DINGS J��G+ CONNECTION CHARG_)SE E
NO. DESCRfPT1ON OF WORK FEE
REIMBURSEMENT FEEV. ". _
HOUSE SEWER CONNECTING TO p
PUBLIC SEWER 0 S- 3.50 J RECEIPT NO. _ DATE *, r BY 'y
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR / XCEPTIO ECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING 0' OA BY
SEWER OR DISPOSAL SYSTEM IOo
DISCONNECT AND ABANDON SEWER ..
_ AND/OR DISPOSAL SYSTEM 1.00 ^� CONNECTION DATA
SEPTIC TANK.SEEPAE
PAND/OR GRA NFIELDT OR
TS 2,00 STATION ,J-t O
� DEPTH
CESSPOOL— L
SPECIAL CONDITIONS ONLY 2.00f^�1C 2��MAN PPE FERENCE ' �SI
.-. TYPE OF CONNECT O'— LENGTH F OM 3 G
OWNERS PERMIT P.L. M.L.
ON
AUTHORIZATION I TOTAL FEE GoNN. pE L Qi2.
CONAED NTRACTOR TO CONNECT THE ABOVE 0 SCRIBEDHEREI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER —
SIGNED THIS..-_��-------DAY OF.........�"..............19_YU NEW HOUSE SEWER S'(./�yfj�� /—�� 1rte
AL . f
OWNER OR .� �' < �_; / BUILDING OR WORK
.': OWNERS AGENT..gz.L!Ll.;,.l._.. - {1 !. ��..__.._
rJ .(_. - SEPTIC TANK.SEEP.PIT(S)
ADDRESS._.__......__.._.._. V -----------------_---..._......_........._.........._.., AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:I DRYWELL E]
CATION 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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTICTANKS E]
SIGNATURE
/ SEEP.PIT(S)0 CESSPOOLS
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OF PERMITTEE.-e—.._.._-
7GA642A 663 7/53 A . K,