HomeMy Public PortalAbout10270 LIVE OAK AVE_Sewer__ f DEPARTaffivT OF COUNTY IllNanvEEB SEWER—SEWAGE DISPOSAL
DIVISION OF BUnMING AND SAFETY PERMIT APPLICATION
COUNTY OF ILOOS ®NGIUMI
WILLIAM J. FOX, CCwrITY ENminealse I BUILDING
ADDRESS
FORe�APPjPLICA T TO HLL LOCALITY
ABU DDRESS /� �✓ J U � C � �a NEAREST
—CROSS ST.
LOCALITY DI8TR1 T NO. Ready for Inspection PERMIT NO.NEAREST c
CROSS ST. S
DATE I SUED BY 'r cDATE
OWNER
MAIL E ZN
OE OCCUPANC SK MAP PO
ADDRESS
CITY TEL N0. l/�
`s
CONTRACTOR v/ CO.IMP.NO.
ADDRESS � � �� �(� NO.
CITY TELAO. �� �� TRUN ERMIT NO.
REGISTRATION NO. �� �IP'COUNTY
ROAD PER NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROAbkMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BL
NOW ON LOTT
RGES
USE OF,-'BUILDINGS L.,o}� I G C "_9' CONNECTION CHARGE F
NO. DESCRIPTION OF WORK FE
HOUSE SEWER CONNECTING TO REIMBURSEMENT E
PUBLIC SEWER 0 $ A 0 _ �O RECEIPT Cr DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING S NO- I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIHFIELD 2.00 STATION �¢'� (,� DEPTH _®
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 3/ 4 MA UPPER EFERENCE i
TYPE OF CON14ECTIO LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L • M.L.TO P.L.
AUTHORIZATION TOTAL FEE 1 156
1HAVE THIS DATE CONTRACTED WITH TI-Et HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE D RIBED EXISTING- APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PU�IC SEWER d
SIGNED THIS �—�D' Y OF_-- 19 NEW HOUSE SEWER �7
OWNER OR r CONNECT ADDITIONAL
OWNERS AGENT..____ _ -�� �r ...............�- BUILDING OR WORK
ADDRESS..._......__._.._..._. SEPTIC TANK,SEEP.PIT(8)
•••-•-•---••-----------•-----•-•—•- AMD/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE i
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS Al 8 COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNI OR THAT I AM T LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE�8C BED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKSEl
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SIGNATURE �J SEEP.PIT(S)[] CESSPOOLS �If�
OF PERINITTE .- _.
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