HomeMy Public PortalAbout10641 LOWER AZUSA RD_Sewer__ • :DEPARTMENT OF COUNTY ENGINEER ��WER®SEWAGE DISPOSAL
DIVISION OF "BUILDING.AND SAFETY PERMIT APPLICATION
�- COU14TY OF LOS ANGELES I
WILLIAM J. FOX, COUNTY ENGINEERBUILDING �
f I ADDRESS
FOR APPLI ANT TO FILL IN ' LOCALITY'/ CLX �,
BUILDING v
ADDRESS Y/�� Cru �J'y „ftf!Lt 'CROSS ST.
DISTRICT NO. SERIAL NO PERMIT NO.
LOCALITY 1
NEAREST S
CROSS.ST, g yj
RECEIVED BY. Ready for Inspection DATEISSUED
OWNER /�4. %1•� °L. I - Ip
MAIL
ADDRESS L e) :q � //w�- �jyy�(,�/�'Q,�/q USE ZONE OCCUPANCY - BK,MAP PG
CITY � Sf �n.�71R.ts.t
TE
L,NO./T•
CONTRACTOR ` LJ. �'ij.5,�-@rL f "1G0
•G0.-4MR:-NO.
ADDRESS qq���� ,7Zt-/����
4y, !/(/yG+G G,111e'C C�a JOB NO. LQ�TS
Q .�. � TRUNK
r .
', CITY �.� c� /" TE�L7.NO. TRUNK PERMIT N0. �"•—""'�-�� - ,.
4 El STATE
REGISTRATION N0. ROAD PERMIT NO.
LEGAL - }
DESCRIPTION' LOT NO. PSTATE ERMIT NCROACHMENT
BLOCK TRACT 91 NDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOCS.
el NOW•ON LOT CHARGES 7 .
USE OF,
GS ;- CONNECTION CHARGE-FEE
NO. DESCRIPTION OF WORK . FEE
HOUSE SEWER CONNECTING-TO REIMBURSEMENT FEE, X,
PUBLICSEWER 0 $ '3.50 � { RECEIPT NO. I� DAT . I BY'
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM L00
CONNECT ADDITIONAL BLDG.OR t EXCEPTION RECORDED\
WORK TO HOUSE SEWER .1.00
ALTER OR REPAIR EXISTING NO- I DATE- I BY
SEWER OR DISPOSAL SYSTEM 1.00 i
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM I.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION" 14 QO, d DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / '^` MANHOLE REFERENCE
�! 7- Yv D l UPPER 6WhjjR
TYPE OF CONNECTfON' LENGTH FROM
OWNERS PERMIT' $ 1 00 t x:- CURB"' P.L. An�M.L.TO P.L.
AUTHORIZATION. TOTAL FEEa
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED: "
CONTRAGTOW TO CONNECT THE ABOVE DESCRIBED EXISTING f' APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER .
SIGNED THIS-----------------DAY OF .................................19•---,-j NEW HOUSESEWER � i^DG /
OWNEROR ff CONNECT.ADDITIONAL
OWNERS.AGENT _
-------.-f BUILDING OR WORK
---------------
--------------------------- I -SEPTIC TANK,SEEP.PIT(S)
ADDRES&c--------
---- ------------••---•--------- AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-1 CESSPOOL 0 DRYWELL❑'
CATION AND STATE THAT THE ABOVE IS CORRECT.AND AGREE'
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS' ' ALTERREPAIR,SEWER OR
,
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY
R DISCONNECT PLUG AND
AND/OLICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON PLUG
AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKF LL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E],CESSPOOLS E
OF PER o .�`b°l�LH� y ^.
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