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HomeMy Public PortalAbout5112 GOLDEN WEST AVE_Sewer__�� .'C"oa." w ,....,�� APPLICATION FOR PERMIT COUNTT OF Loll "el�ISEWER SEWAGE DISPOSAL DEPARTME2f'f OF COUNTY ENS I3DII.DINdl AND SAFETT M{?MON BUILDING ��O���������� ADDRESS MLId.IAI[L Tom" aaPi +s ��4 LOCALITT NEAREST FOR APPLICANT TO FILL/I'N l CROSS STLEGAL . { DESCRIPTON Sr LIT' C ! 'OTNEB Ir BLOct TRACT SL MAiL ADDRE>i7 NO.OF BLDGS, .. . SIZE OF LOT NOW ON LOT Zl C U33p��DF BUILDINGS QILIr " owiu No. GAOU BE IrAP dT to NT mjt Q go.-7 ��{ APQRESS ! W 3 - po YYl G ON DATA TA TEL N0. /f'r7 Z STAtOM MITH �� Mkaoa C RLGISTRAnoR No. ciCL - ; UPP N6 p ERWIP ION OF WORK, FEB /�� IUB E 5,E E RCONNECTIMa TO. 91 V.DO J. ��l1 _ . TTPE OF CO VECTION L��IGTi �%fY0 SEPTIC TAH K.SEEPAGE PIT R T. CURB T PITS AND OR DRAIN FIELD UVERFLGW SEEPAGE PIT DWNFIL?W - PO DR HOUSE R CONNECTI G TO F. *0. WPRI 41P $1.0-QNW A 71 X.{ CO.IMP.lyb. JOB NO. M ��ieRK��o liOU SEl�%ERBLDG" OQ TRUNK PERMIT NO. ROAD P R.MI_T NO. q A6 A) ��M AI 0 ABAHD N HOUHH .00 STATE 6NCROAcHmExT PERMIT NO. IXDU At PROV CHAIIGRH OwNmra P$g '1< p 00 FoNNECTION�RAR"nix AlMMOHMATION I TOTAL 0 Rai.IiURSE III E11T��F$Q I HAVE AT THIS DATE A CONTRACT WITH TH9 HERI;-INII- CON, ��T�� TMRP B' CO"S T TIE ADQVE DESCII1BXD.�I371}I4'D*ELLIN4 APPROVALS DATR 7NSPECToirt iI "THY TH��E SIGNED TH[q. JAY F NEW HOUSE SEWER OWNER OR CONNECT ADbIT19KAL OWNERS AG'EN'T `r BULLDING.Ok WORK ADDRESS I v S��TIC T/l����HMA SEE PFT(f} AN OR" O AI PITTE 1 HEQBBT ACKNOVfLEDGE.TRAT.-1 HAVE READ IS APPLICAT1O - - - -AN STATE Ti AT THE jBOYE 19 GORR CT AND A REE TO CDYPL CESSPOOL DRTWXLL M1�� ALL coUMTI' ORDIHANCu Ailb STATE TAWS REGULATING PLU BIND AND SE��ERf_ ALTER,RREPAIR��SEVER OR f HEREBY CERTIfT THAT 1 AM PROPERLT "GISTEAED AND/0R SEWAGE DISPOSAL SYSTEM ycgxSEp AS REQUIRED LIT LRS AN9ULS Cp+yIM AND STATE OF D'��CONNE PLUG/��1D _ CALIFQQRKIA OR T 1 AY THE LEGAL I= OF THE ABOYH ��M}MOUSE SE EII DFS CRIBED REBID TMA{. P cKfILL SEPBC7ANKE SEEP.PIT E CESSPOOLS SIGNATURE ' O PERYi ATIQN Ro ��-r A. WOOD CS Fail supX rvisiNO Y6c1-IAmicAL-xNcmNPLm{ N 2622 SP 14 l 0 .0 5', 10