HomeMy Public PortalAbout9342 LOWER AZUSA RD_Sewer__ DCPARTA>DENT OF COUNTY ENGEKEPM SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS "GEMS BUILDING f- '
WILLIAM J. FOX, COUNTY ENGINEER
ADDRESS
FOR APPLtq6NT TO L IN LOCALITY`
BUILDING NEARESTt'
ADDRESS . Ls. /f9i •+*.;+ � CROSS ST. n+�
LOCALITY
.� (� DISTRICT NO. SERIAL NO. �^ P RMIT N0+
-f...� '" '''� '� �' j A oilNEAREST V �• „
CROSS T. /,[, >/ �'�. JJ/ ,I:d,oV I RECEIVED BY Re dy o o peotie DATE ISSUED
OWNER 1O �.�%iV' C
r7 Q
MAIL
- - -� �-j-/,t� �' • .�.�`f USE ZONE OCCUPANCY BK MAP PG
f\r
,>
ADDRES. f'r-.� ♦ �•r. l• -
CITYTELNO. •� > t� ' I V y`P
CONTRACTORly
p, / _ ?�a('•.)/Jfy>t'.tr { �a� a I ri Ca
ADDRESS J ? JOB.N0. 4
CITY TELNO. TRUNK PERMIT NO.
STATE
REGISTRATION NO.4 A � � COUNTY ROAD PERMIT NO. ^�---+
a
DESCRIPTION t;aT NO. r � C�' *f�a STATE ENCROACHMENT
v/ d PERMIT NO.
BLOCK TBACT,& ,I, ��iLL���'�e°�//a V? 'INDUSTRIAL - ---
r WASTE APPROVAL
SIZE OF LOTNO.OF BLDGS,
NOW ON LOT CHARGES
��
BUILUSE DINGS ��. `/L`„•:a-,z=. CONNECTION CHARGE FEE��j{�
NO. DESCRIPTION OF WORK- FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO I
PUBLICSEWER / 0 $ S.SO RECEIPT NO. DATE B
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. DATE - ,I BY--
SEWER OR DISPOSAL SYSTEM 1.00
DISCONECT AND ABANDON
AND/ORRDISPOSAL YSTEM SEWER 1,00 CON
NfCTION:DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION .-- _'-,DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /MANHOLE REFERENCE`S
�t UPPER ` LOWER
Y. TYPE CURNBNECTIO P.L. MEL.TO P.L.NGTH OM�
OWNERS PERMIT $ I oo �.-
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH&PUBLIC SEWER
SIGNED THIS _ i_DAY�OF �' _Igs�'� NEW HOUSE SEWER
OWNER OR �? 4 CONNECT ADDITIONAL
ti�� �7 - BUILDING OR WORK
OWNERS AGENT..._.:.._,: �....._._� -
f SEPTIC TANK,SEEP.PIT(S)
ADDRESS......._. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE$EWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVA DE�IBEO RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[:] '
{S/�J/ ' SEEP.PIT(S)[] CESSPOOLS
SIGNATURE ,�'�
OF PERMITTEE.-- - .`.=._.._.�._..__...._.._.
7RARARA Rea 7/tiA !
PFPAB.TBiENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN I LOCALITYBUILDING _ _
A 60 .��,S Ugh NEAREST
ADDRESS
3 Lyezr.: CROSSST.
LOCALITYS1 ,- DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST. [_'j'✓/T cr .'4 ✓'1= -
J) RECEIVED BY BY Ready for Inspection D /E ISSUED
OWNER ) � �$ -!/✓Q-L, ✓ d
MAIL B r `� '
ADDRESS 7 5 0. 6 ��'�' �= t1S USE ZONE OCCUPANCY qK MAP PG
CITY E# S E Cci t( TEL.NO/. J: zr
CONTRACTORJsyT� � /C4ssy GO.IMP.NO. " ice,4
ADDRESS /2-I.S. .S/1 a@-y ".Lr JOB.N0. —
CITY 1,o� ', TELAO. _
TRUNK PERMIT N0.
STATE
REGISTRATION NO. (f i ; �3 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT d`C, INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT X�f'O NOW ON LOTS % CHARGES
USE OF
BUILDINGS DINGS 'y _ CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE -"" •- -'
" HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT N0. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYS_TEM 1.00
CONNECT ADDITIONAL.BLDG.OR EXCEPTION RECORDED
--WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' DATE i BY
_SEWER OR DISPOSAL SYSTEM 1.00 -
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION ��r{J DEPTH C
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 _2 MA PPE ERENC �` a
Pa YPE OF CONNECTION LENGTH FRO!!
OWNERS PERMIT I I OO Y. ""@rAr M.L.TO P.L. j
AUTHORIZATION ! TOTAL FEE `"' 1-,'
HAVE 1N NAED 11
CONTRACTOIS DATE R TO CONNECT THTE ABOVE DESCRIBED ED W TH THE IEXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS------- ...........DAY OF_..................—.......—......19__— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT........................................................................ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS_..................................................................................... AHD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLI- CESSPOOL� DRYWELL E]
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 I AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
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)o CESSPOOLS
Cf ..+G�
OFPERMITTEE.---•-•......--.._f_.-_----_._._._...---.........--.................._...._,.
78AF,42A 661 7/5R