HomeMy Public PortalAbout10659 LOWER AZUSA RD_Sewer__ DEPAxr111714ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING-AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
NG
WILLIAM u.- FOX, COUNTY ENGINEER [ADD EISS
FORAPPLICANT TO FILL IN LOCALITYBUILDING
EAREST
ADDRESS /V • f`.aILi I CROSS ST. SC l Y t ( /!ll `�✓
LOCALITY DISTRICT Po0. SERIAL N0. PERMIT N0. C
NEAREST- J A / �!° °� J
CROSS ST. ` "' �- RECEIVED BY Ready for Inspection DATE ISSUED
OWNER /�/ ,./�//, ` 4 /
MAIL J Pn..4i �N`1/� /J�elf'Il1 (f1E ONE �rBK
APP
ADDRESS y s USE ZONE OCCUPANCY MAP
CITY TEL.NO.
CONTRACTOR /6 /� ��% 4 �ylv� �� • ' `
ADDRESS 'At-'AJOB NO.
CITY TEL.NO. Q 'TRUNK PERMIT NO.
REGISTRATION N0. O+t30ATE
ROAD PERMIT NO. <
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LEGAL
DESCRIPTION LOT N0. 7 PERMIT NNOROA`CHMENT
BLOCK TRACT / `l1 �Y47 INDUSTRIAL
AL
SIZE CF LOT N0.OF BLDGWASTE APPROV
S. P
NOW ON LOT \ CHARGES
USE OF
BUILDINGSt.Jd•�! /" n,yrt�•� CONNECTION CHARGE FEE J
NO. DESCRIPTION OF WORK FEE
/ HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 ( RECEIPT NODATE\ I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1:00
CONNECT ADDITIONAL BLDG.OR / EXCEPTION RECORD
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO ( DATE
SEWER OR DISPOSAL SYSTEM 1.00 \
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR p�
PITS AND/OR DRAINFIELD 2.00' STATION f/ DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 tN d7 ER MANHOLE
REFERENCE "hO R-
(TYPE OF CONNECTION `_.—LENGTH FROM /
OWNERS PERMIT $ 1 s-00 X Ct"m P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE'
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-----•-a NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL
ti
OWNERS AGENT-•-------------------------------------••----•--....................-• - BUILDING OR WORK
ADDRESS—_._--__....____-___-----------...._ t SEPTIC TANK,SEEP.PIT(S)
- - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[-] CESSPOOLS
SIGNATURE
OF PERM ITTEE � ; ....�S� �
.--=--•------�-•-----------•--- --•----- ----•-=--...._
76A642D 663 1/53yi " ?� $ T