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76AG67 17 25M SETS 4APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
, COUNTY OF LOS ANGELES PLUMBING f
WM.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE P RMIT NO.
ROUGH FIXTURES COMPLETE
HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED
n,C FIRST INSPECTION /d
GAS MISCELLANEOUS o _
mumammm am
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
0! NAME ;� / �Y'f ADDRESS / ' ��L. / injvGt f
ADDRET' r /? Gfi1/�!D L /�Y''Y t� NEAREST
/ LOCALITY
L CITYC/�f b /B ( ,/ �y1���(� CROSS
COUNTY //�
LICENSENd 00 / EXPIRES`, 1/ m .NAME
LOCATION OF SEPTIC TANK, OR IdEOL z MAIL
3 ADDRESS
NORTH O
CITY TEL.No.
I AM THE LEGAL P084CSSOR OF THE ABOVE LOS
} ANGELES COUNTY CERTIFICATElOF q ALIIIFICATION.
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P{:UMB@R
1 AM THE LEGAL Q_WNER OF THE PROP€RTY DESCRIBED
ABOVE. (!
3 : 1 OWNER
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK
BATH TUB FURNACE
Qr
ROWER DISHWASHER O
-LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR BINK SAND TRAP
GLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
I I DATE
,, �f�/ INSPECTOR'S NAME
-WATER HEATER DENTAL LAVATORY ROUGH PLUMBING 16"m"90"m"9AY1 I
METER GAS SODA FOUNTAIN GAS PIPING I,
OUTL
GAS VENT
qq_/� CESSPOOL
J
TOTAL NUMBER OF FIXTURES Q SEPTIC TANK I I
CEBSPOO� SEPTIC TANK SEWER I I
S UTILITY CO.NOTIFIED
TOTAL FEE
FINAL