HomeMy Public PortalAbout9326 LOWER AZUSA RD_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL ' 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
' WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICA ,TO FILL IN LOCALITY
BUILDING�j r` ` NEAREST
ADDRESS CROSS ST.
LOCALITY J DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST'-"" �" A S
CROSS ST. {��t�
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER r f ,
MAID USE ZONE ( OCCUPANCY MAP
ADDRESS s a 1C I BK PG
CITY TEL.NO.
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB.NO.
CITY TEL.NO. TRUNK PERMIT NO.
[❑J STATE
REGISTRATION NO. Q COUNTY ROAD PERMIT NO.
LEGAL y STATE ENCROACHMENT
DESCRIPTION LOT No B PERMIT NO.
BLOCK TRACT INDUSTRIAL
-�--�-�-�-y WASTE APPROVAL
SIZE OF LOTc_-, N0.OF BLDGS. G
NOW ON l0T CHARGES
USE OF
BUILDINGS gr.z-»° CONNECTION CHARGE FEE
NO. DESCRIPTION vOF' WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO —
PUBLIC SEWER Q $ 3.50 RECEIPT NO. ( DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITfONAL BLDG.OR EXCEPTION RECORDED
__WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT ANQ 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 $ I I 00 Y. CUPS P.i.: 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 APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER'
SIGNED THIS __ DAY OF. �., �,1 NEW HOUSE SEWER
; i CONNECT ADDITION
ALOWNER OR BUILDING OR WORKOWNERS AG /4.
SEPTIC TANK,SEEP.PI
TS)
ADORE ..._- u _ -----_
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I,H VE READ THIS APPLI- CESSPOOL 0 DRYWELL(�
CATION AND STATE THAT THE ABOVE4S 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 IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/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
SIGNATURE SEEP.PIT(S)[] CESSPOOLSE]
OFPERMITTEE.......... ----------•...:..........—... - - :_....-----------
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