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DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FI L IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
4
LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO.
i
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USEZONE I OCCUPANCY I MAP
BK PG
CITY TEL.NO. }
CONTRACTOR
CO.IMP.NO.
ADDRESS
t--- Y"r-ka- '-��. - JOB NO.
CITY 1 - TE L.NO. I.1 y�/ �
w d TRUNK PERMIT N0.
❑ STATE
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT N0.OF BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER Q $ 3.50 RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PR.VATED:SPOSALSYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE IBY
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/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y. CURB --- P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE �--2-1
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF----------------------------------------19----.... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-----------------------------------------------------_----_-------------- BUILDING OR WORK
_
ADDRESS------------------------------------------------.---------------- SEPTIC TANK,SEEP.PIT(S)
DRA- ^— AND/OR SEPTIC
SEEP.
ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
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 AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE �/'' ® SEEP.PIT(S)❑ CESSPOOLS
OF PERM ITTEE..I, s-G_ 4!5 .%d501--- ----- -----.1
76A642D 663 1/53
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGBUILDINGINEER ADDRESS a l,3FOR APPLICANT TO FILL IN LOCALITY `T movie' "'P" Ll
BUILDING ���.� /� r ' NEAREST / 7n
ADDRESS (�"� /' Cj! / CROSS ST.
LOCALITY 7eL
/ DISTRICT N0. SERN0. PERMIT NO.
'-sal yAL
_
NEAREST
CROSS ST. /
RECEJVED BY Ready for Inspection DATEISSUED
_OWNERMAIL
�V L2 �.��cam/ II !fJ `� ✓ _-�
ADDRESS USE ZONE OCCUPANCY MAP
BK PG
CITY TEL.NO.
CONTRACTOR/7 �,Zl 9:�,
CO.IMP.N0.
ADDRESS_21? i i YrQ �Y»7C� JOB NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. r/ g COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. i/� jti 2 /J y�pf, STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT �� )� 1� L),,, ,. p} y¢i INDUSTRIAL
WASTE APPROVAL
SIZE CF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ S 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
P RiVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDIS.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO* 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 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT = 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION [ Ieg I PC
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS..... .1.._._DAY OF... ..........19_:x_-- NEW HOUSE SEWER
OWNER OR r CONNECT ADDITIONAL
OWNERS AGENT_' 1�iLt'ir..._._ �Y:. __--_.-__---.._.-_ BUILDING OR WORK I
' ( ,( SEPTIC TANK,SEEP.PIT(S)
ADDRESS.... ....... -- -^. ": -------i'`..................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL
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 ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE '/ SEEP.PIT(S)Ej CESSPOOLS I]
OF PERMITTEE, i .?ea>�:..
76A6421L 663 1/53