HomeMy Public PortalAbout9358 LOWER AZUSA RD_Sewer__ IsaE.S•eS3 11' 3.53 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING = q,
ADDRESS
WM.J. FOX. COUNTY ENGINEER a-
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY-
FOR APPLICANT TO : 'Ii,I. IN NEAREST -7 ----'�
..-.._ CROSS ST "✓J�-F
LEGAL
DESCRIPTION LOT NO OWNER ✓� '�"
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BLOCK TRACT MAIL -
- N0. OF BLDGS,W rte_t T ,�
SIZE OF LOT NOW ON LOT _--,__-_- _ CITY �-� ,y„'. .' I"' TEL. NOb. w..i' •` ,,,' L
-USE OF
DISTRICT NO, GROUP MAP
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CONTRACTOP,
ADDRESS ,>�- J � %% :�.�' CONNECTION DATA
CITY %'/�'� �6- r d'c- TEL. Nfl..� -'� --'�f STATION DEPTH
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&FAATTE MANHOLE REFERENCE . °'Eq-.
—
REGISTRATION NO. !Y j' ❑ COUNTY
NO. DESCRIPTION OF WORK FEE ------------------- -.----- ----- ---.-------
'YYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO �p~ r y. CURB P.L. M_LGTO P L
PUBLICSEWER_ _ �i $ 3.50 .-_,.. .�-._--
HOi,SE SEYJ ER CONNECTING TO—
PRIVAT£-DISP_OS_AL SYSTEM 5.00
CONNECT ADD1T10NAL BLDG. OR [ CO. 1MP, N0. JOB NO.
WORK TO HOUSE SEWER _ 1 00 -----IMP-NO.-- J ------ ....----- ---
ALTER OR REPAIR EXIST.ING�
EWER OR DISPOSAL SYSTEM _ 1.00 TRUNK PERMIT N0, ROAR PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM p�1.00[ PERMIT l O.
SEPTIC TAIvY., SEEPAGE PIT OR -----`- ---"-- _ �. .---- —
PIT_S_A_ND/O_R_GRAiNFIEL-_D 2.00 INDUSTRIAL
CESSPOOL-DRYWELLr - -- -� WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S 00
----- --_
AUTHORIZATION TOTAL FEE � � �- REIMBURSEMENT FEE
I HAVE THIS DATE CONTP�`--TED WITH HE HEREIN NAMED CON- APPROVALS DATE �iN3PECTOR'5 SIGNATURE
TRACTOR TO CONNECT `tHE ABOVE DESCR,.,BED EXISTING DWELLING Jt' L3L
TO THE PUBLIC StV-eR _ ---`-----
1 NEW HOUSE SEWER -
SIGNED THIS ,DRY Oj
_ - -CONNECT ADDITIONAL
OWNE4, OR J' -z&-y;�-_f, a,�. �$, _ _ BUILDING OR YAORK
OWNERS AGEN, �.:,f',: ---_ -.—_ -
SEPTIC TANK,SEEP, PIT(S)
ADDRP>c _� ..�'. �C,-- .- AND/OR DRAINFIELD_� ��--
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL L.7 DRYWELL[I
AND SPATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -�,•_ _^ _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR. SEWER OR
PLUMPING AND SEWERS. SEWAGE DISPOSAL SYSTEM.
I HEREBY CERTIFY' AT i AM PROPERLY REGISTERED AND;CR - --
LICENSED AS RERU,IREBY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT!I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SE%',ER _
DESCRIBED RESIDENT AL PROPERTY.
BACKFILL SEPTIC TANKS C
SEEP. PIT(S)0 CESSPOOLS C3
SIGNATURE s::•= i s s �-
OF PERMITTEE��- -
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR