HomeMy Public PortalAbout9933 HOWLAND DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DOSP SAL
DIVISION OF BUILDING ARID SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING 9� � ` ` I f�
CASSATT D. GRIFFIN, SUPT Or BUILDING ADDRESS {--
FOR APPLICANT TO FILL IN LOCALITY
BUILDING /�J® e a �� , /�h A/ Jy NEAREST e
ADDRESS i r p (IBJ II/) 1�1� CROSS ST.
LOCALITYn. / DISTRICT NO. SERIAL Nb, . PERMIT NO.
NEAREST !!! 5 A \ `�g go_-S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED il '>.{.,
OWNER 2.
. _
ADDRESS SMAIL A m P— USE E OCCUPANCY MAP
BK PG
CITY TEL.NO,
CONTRACTOR ` CHARGES REIMBURSEMENT FIE
ADDRESS / �t REQUIR
CITY er
e I r 7.2/2 NOT REQUIRED
TELAO. PTNECTION CHARGE FEE
���'dddd JOB.NO.
/ ® I env STATE `
REGISTRATION NO. o CO.IMP.NO.
1 3C7�"
LEGAL g/oe RECEIPT NO. � DATE BY
DESCRIPTION LOT N0. Q
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOT
NO.OF BLDGS.
�`�� NOW ON LOT 1 PT NO. I DATE I BY O,
USE OF
BUILDINGS q ',4 A TRUNK PERMIT NO.
NO. DESCRIPTION OF RK FEE
HOUSE SEWER V
1 PUBLIC SEWERG 0NNECTIVTO 0 $ 3.50 3 —U ROAD PERMIT NO 7-) Q( G�
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00
SEPTIC TANK,SEEPAGE PIT OR }� �STATION DEPTH
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE CE c LOWER
CESSPOOL—DRYWELL UPPER
SPECIAL CONDITIONS ONLY 2.00 I�
TYPE OF CONNECT ON LENGTH FROM
�CURBiib. M.L.TO P.L.
OWNERS I PERMIT $ 1 00
AUTHORIZATION TOTAL FEE 4.5O
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_____.n_..._ "DAO _' ._.__._._"_ 19 � NEW HOUSE SEWER ya✓�v.
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.............." ' n'f`�� BUILDING OR WORK
. ..... ........ ...................
---- SEPTIC TANK,SEEP.PIT(S)
ADDRESS- .. .. .. -------
I
._ AND/ORDRAINFIELD
,r
r
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL
CAT
ICN AND STATE THAT THE ABOVE IS CORRECT AND.AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 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 AIN THE LEGAL OWN-
ER OF THE ABOVE D CRIBED RESIDENTIAL PROPERTY BACKFIILSEPTIC TANKSO
SEEP.PIT(S)[] CESSPOOLS®— SG i A C I'
SIGNATURE
OF PERMITTE .... l' ........�-c"...?w(S!� '
76A6420 663 12/32 } ! �