HomeMy Public PortalAbout10831 GRAND AVE_Sewer__ DEPASTMENT OF OOUNW ENCIRCEER _ - SEWER-SEWAGE DISPOSAL 1
DMSION OF BUELDING AND SAFETY PERMIT APPLICATION
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WILLIAM J. FOX, Courm ENOIN[[R BUILDING
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RICT NO. A SERIAL NO. PERMIT NO. C
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TRUNK IT 1110.
ATE
REGISTRATION NO. COUNTY ROAD PERMIT N
LEGAL STATE ENCROACHY 691,
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT llqO INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS CHARD
W ON LOT
USE OF CONNECTION CHARGE FEE
BUILDINGS
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOU8 S R CONNEUHWG TO
PUBLIC SEWER 3-m REOEIPT NO. DATE BY
HOUSE SEWER 0ONNI1=NQ TO
PRIVATE DISPOWIL SYSTEM I w
NN R06.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER I.DO
ALTER OR REPAIR ISTING NO. DATE BY
SEWER OR DISPOSAL SYSTEM Im
DISGONNEOT AND ABANDON SEWER
AND OR DISPOSAL SYSTEM 1.0� CONNECTION DATA
PT TANK 8 PAGE PIT OR `
PITS AND/OR DRAINFIELD !.N STATIONDEPTH
POOL—DRYW[LL
SPECIAL CONDITIONS ONLY 2.OS 4 ANHOLE REFERENCE L E
PE OF 00 VECTION ENGTH FROM
Y. OU RB P.L. M.L TO P.L
OYVNER$ PERMIT ; I
AUTHORfZAMN I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOFt'8910NATURg DATE
DWELLING TO THE PUBLIO SEWER
SIGNED THI Y 19 NEW HOUSE SEWER /`�
OWNER OR BUILDING ORDWORKAL
OWNERS GE
BJiPT1C TANK.SEEP.PITS)
ADDR AND/OR DBAINFIELD
I HEREBY A KNO [DG[ THAT I HAVE READ THIS APFLI• CESSPOOL E] DBYW[LL E]CATION AND STATE THAT THE ABOVE IS DORREOT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIRjEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPO L SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTER-
AND/OR LICENSED AS REQUIRED BY LOS ANGELES BOUNTY DISCONNEOT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AY THE LEGAL OWN. ABANDON HOUSESEWER
ER OF THE ABOVE D[SORIBED RESIDENTIAL PROPERTY. 0 AN ❑
SIGNATURE BEEP.PIT(S)� CESSPOOLS
OF PERMITTEE
TBA 42A 683 T/68