Loading...
HomeMy Public PortalAbout10631 LOWER AZUSA RD_Sewer__ ]Q,7,PAlVrMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES ' WILLIAM J. FOX. COUNTY ENGINEER BUILDING ADDRESS �l\j .]1 ,e� FOR APPLICANT TO FILL IN LOCALITY c � _Cj BUILDING NEAREST ADDRESS �����' O��w vL �l�'J�f CROSS ST. LOCALITY (^v DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST CROSS ST. I A l / L� S /RECEIV Ready for Inspection / DATEISSUED OWNER �' o ",..11�j////rrjj�J MAIL ADDRESS Z ., USE ZONE OCCUPANCY BK MAP PG CITY iy�,sG/C7 D TEL.NO. 91-131,V CONTRACTORL ADDRESS vvvY / q('+� JOB N0. V CITY C%LLeW TEL.NO. �,[O. (O❑��J d TRUNK PERMIT NO., STATE REGISTRATION NO. 3 — I .Q=COtI TYI ROAD PERMIT N0. \ LEGAL / DESCRIPTION LOT N0. PENCROACHMENT PERMIT NO BLOCK TRACT INDUSTRIAL / WASTE APPROVAL / SIZE CF LOT. N0.OF BLDGS. NOW ON LOT 6rARGES USE OF e/ BUILDINGS �yC./y �IGJL�E".-�i� i CONNECTION CHARGE FEE / NO. DESCRIPTION OF WORK FEE J HOUSE SEWER CONNECTING TO I REIMBURSEMENT FEE PUBLICSEWER @ $ 3.50 3RECEIPT NO. I / DAT BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM I.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 1 1 ALTER OR REPAIR EXISTING NO. I DATE , \I BY SEWER OR DISPOSAL SYSTEM 1.00 1 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK.SEEPAGE PIT OR .PITS AND/OR DRAINFIELD 2.00 ' STATION ©LQ�' 6 DEPTH (9 CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 r/ _ V NHOLEREFERENCE LOWER L S TYPE OF CONNECTION ��LENGTH FROM / -Y:1 CtIRB P.L. M.L.TO P.L. OWNERS PERMIT $ /L1 00 AUTHORIZATION I TOTAL FEE 7 �' I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED; CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING, DWELLING TO THE PUBLIC ,SEWER APPROVALS INSPECTOR'S SIGNATURE DATE SIGNED THIS--------------------DAY OF........................................19..._...I' NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT-----------------------------------------------------------------------------I BUILDING O R WOR K SEPTIC TANK,SEEP.PIT(S) ADDRESS-----------------------_------------------------.............................. _-..( AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-%A' CESSPOOL[-] DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE 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: DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY. AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-`• ABANDON HOUSE SEWER ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E] SIGNATURE SEEP.PIT(S)E] CESSPOOLS E] OF PERMITTEE--- ®wrY! - : 76A642D 663 1/53