HomeMy Public PortalAbout10827 GRAND AVE_Sewer__ DEPART OF OOUNTY ENCUNIME SEWER-SEWAGE DISPOSALS 4 2 7 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF LOS ANGET,
BUILDING
WILLIAM J. FOX, CouNrY EHI31NrER I ADDRESS
FOR APPLICAN O RLL IN LOCALITY F
BUILDING NEAREST %
ADDRESS / CRO SS ST. i
LOCALITY DISTRICT N0. 9EAIAL N0. PERMIT NO. C
NEAREST A S
CROSS 8T. .r1�� RECEIVED BY Rfady for lupoctleo DATE 188UED
OWNER / f�
YAR U�EP
ZQNE OCCUPANCY YA
ADDRESS w , BK PB
CITY TELNO. �11t��-
coNTR'`oT al i Pnrnig hexer nnug%oma^^vL CO.IMP.NO.
ADDRE88 1 17 C'nl a g r n i r P JOB 0.
ClTyMOntnhFil l n TE�fti Ci>Z ] r�eAfl TRUNK ■ITNO.
ATE
REGISTRATION COUNTY ROAD PERMIT
LEGALSTATE ENCROACH NT
DESORIPTION LOT N0. PERMIT NO.
BLOCK TRACT Z) - INDUSTRIAL
WASTE APPROVAL
SIZE OF LO NO.OF BLDGS
NOW ON LOT ES
USE OF
BUILDINGS CONNECTION CHARGE F
NO. DF-Sr-RIPTION OF WORK FEE
HOUSE SEWER CONNEOTIN TO _ REIMBURSEMENT
PUBU08EWER Q # us RECEIPT DATE
HOUSE 0ONNECTING To Ply-
PRIVATEIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL 13LDIL OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
AL P NB NO' DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABAN ON SEWER
AND/OR DISPOSAL SYSTEM LIKI CONNECTION DATA
TANK,
SEEPAGE PIT OR
PITS AMD ORDFWNFIELD 2-09 STATION 'OLDEPTH
SPECIAL CONDITIONS ONLY 2.MJ NIHOLERREFERENCE �
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT 1 CC P.L. Y.L TO P.L.
r
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC BEWER C �/
SIGNED THIS Z-1DAY I NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS ADEN BUILDING OR WORK
WADDRESS SEPTIO TANK]SEEP.PITS)
AND ORD
DRA NFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- OE88POOL[:] DRYWELL E]CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERW SEWAGE DI8PO�ALSYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND LICENSED A8 REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR AT I AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE ED DRIITIAL TROPE 0 S AN
SIGNATURE SEEr.PIT(S)� CESSP00L6
OF PERYITTE r.,
YdA6ltA 603 1/63 A/