HomeMy Public PortalAbout2000 LOWER AZUSA RD_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS A.NGELW
BUILDING
WILLIAM J. FOX, COUNTY €NGIN[EADDRESS
S
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING . NEAREST
ADDRESS �'@ CROSS ST.
LOCALITY _ DISTRICT NO. Ready for InspectionI PERMIT NO.
NEAREST S
CROSS ST
RECEIVED BY DATE f ISSUED BY DATE
OWNER � ':, `!
MAIL USE ZONE OCCUPANCY MAP
ADDRESS eta. . BK PQ
CITY ,j r I TEL.NO.
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB NO.
CITY _ TELVNO TRUNK PERMIT N0.
yyew.�- STATE
REGISTRATION NO. C� COUNTY ROAD PERMIT NO.
LEGAL - _
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF --- -
BUILDINGS - CONNECTION CHARGE PEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING T6____ REIMBURSEMENT FEE
PUBLIC SEWER $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
�ALLTER OR REPAIREXI-TING NO. { DATE �BY
SEWER OR DISPOSAL SYSTEM 1.00
Dl9CONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR —
_ PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—ORYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT = I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS'• ..-.__DAY C'F ....-.a __...a _ 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT c-.:e..-..e.:___-_.,:..;.- -------__....._._...__m_-V,.._.-_--.._ BUILDING OR WORK
ADDRESS AND/OR DRAEPTIC INNELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL Q
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
ASID/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Cl
SEEP.PIT(S)[:] CESSPOOLS
SIGNATURE
OF P RMITTEE.... =_ ,-_ r._ _ ------
T6AG42D- S&E663 4/54
DEFasTNIENT OF COUNTY ENanNEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENatN[ER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. Ready for Inspection PERMIT NO.
NEAREST
CROSS ST.
RECEIVED BY DATE I ISSUED BY DATE
OWNER I{
MAIL
ADDDRESSRESS USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NOu I -
CONTRACTOR ^v CO.IMP.NO.
ADDRESS 108 NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. COUNTY {TOAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT k0.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO,OF BLOCS.
NOW ON LOT CHARGES
USE OF -
BUILDINGS CONNECTION CHARGE FEE T
NO, DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
— HOUSE SEWER CONNECTING TO
`I PUBLIC SEWER- $ 3.58 I RECEIPT N0. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDO.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 --
ALTER OR REPAIR EXISTING NO- ` DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 1
DISCONNECT ANO ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT 1 QO Y. CURB P.L. M,L.TO P.L.
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS -...-_DAY OF..._._ - _ _ _N9 _ .. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT„........._..-»-_..._.__—.._-.__-......-...._._.._..-_._ BUILDING OR WORK
ADDRESS...__._..___». SEPTIC TANK,SEEP.PIT(S)
...._......._...._.._»_.. . .._..�__.,_..»A.r... __ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL[] DRYWELL 0
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
1 HEREBY CERTIFY THAT t AM PROPERLY REGISTERED DISCONNECT PLUG AND
STATE
LICENSED REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND ATE OF CALIFORNIAF !JR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE PESCRIUED RE�1'DENTIAL PROPEPTY.fi,6 .-, BACKFILL SEPTICTANKSQ
SIGNATURE SEEP.PIT(S)0 CESSPOOLS
OF PERMITTEE__. ,'
?6A642D S&E 663 4/54