HomeMy Public PortalAbout10957 GRAND AVE_Sewer__ DEPAICRAWNm OF 0017fvW ENOnqFDEx SEWER ��II/J4Gb/ISPOSAIL
DIVISION OF BUELDING AND SAFETY PERMIT APPLICATION
OOUNW OF I.08 ANGICY
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
' LOOALITY
FOR APPLI TO LL IN
BUILDING NEAREST
ADDRE86 CJI�S ST
LOCALITY DtSTIUCT N SERIAL NO. PERMIT M0.
NEAREST A 1 —S
CR088 ST.
OWNER
IV[D BY Saaft fK Imapow" DATE ISSUED
MAIL
ADDR o r bE ZOM OOCUPAMCY YAP
BK PQ
CITYL.MO. —1
CONTRACTOR
ADDRESS
f� J0B NO.
CIT1V _ TELM TRUNK PERMIT N0. ' 6
STATE
REGIBTRA IOM NO. COUNTY ROAD PERMIT NO. Z�
LEGAL
DESCRIPTION LOT NO. f STATE ENCROACHMENT
�j
/ �j PERMIT NO. ���■
BLOCK TRACT 1334$ INDUSTRIAL
SIZE OF LOT NO.OF BLDGB WASTE APPROVAL
NOW ON LOT ARLES
USE OF �+
BUILDINGS COMNEOTION CHARGE FEE
M0. DE8 I ION F WORK FE lit;' assmkafffm OR
oe-
HOU81 SEWER CONNECTING TO 'QS
PUBLIC SEWER 1 3-50 RECEIPTDA BY
HOUSE SEWERCONNEOTING TO ,
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR );eery GIN-RfeeflDEB
WORK TO HOUSE SEWER IAO
AL B PAI Exfg-ti NG NO. DaTE IR
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
PITT AND/OR DRAINFIELD M"10 TANK,alEtPACE PIT OR 2.00 STAT M DEFTH
CE POOL—DRYWELI
SPECIAL CONDITIONS ONLY LOS RE 8 r y
F WER
PE OF OONNEOTIO B fR0
OWNERS PERMIT ; I 00 qD <1PyY.L TO P.L
AUTHORIZATION TOTAL FEE
1 HAVE THISDATfi CONTRACTED WITH THE HEREIN HAYED `
CONTRAOTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS IMdPECTORSSIGNATURE DAT[
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER re
OWNER OR CONNECT ADDITIONAL
OWMERS AGENT BUILDING OR WORK
SEPTIC TANK BEEP.PIT(S)
ADDRESS -- AND/OR DRA NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLJ- CESSPOOL DRYW[LL
CATION AND STATE THAT THE ABOVE Id CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RSALTER,REPAIR�SEWER OR
REGULATING PLUMBING AND SEWE . SEWAGE DIdPO L ER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AMD/OR LICENSED AS REQUIRED BY L08 ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA ORT T I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D BED DEMTIAL PROP RTY. BAOKFI LL Ftffio TANK8 it G M ATU RE ❑
f.' iEEP.PIT(S)❑ CEst"OL6
OF PERMITTE F
TOA042D MS 1/53 K.