HomeMy Public PortalAbout9366 LOWER AZUSA RD_Sewer__ 76x9.66 APPLICATION FOR PERMIT I
DIVISION OF BUILDING AND SAMY SEWER-SEWAGE DISPOSAL
Depcib out of County Engineer y„^
County of Lou Angeles BUILDING �� �
WM.J. FOX.COUNTY ENGINEER ADDRESS y
CASSATT 0.GRIFFIN,SUPT OF SUILDING LOCALITY p
FOR APPLICANT TO FILL IN NEAREST
_ - CROSS 4T.LEG
DESCRIPTION LOT NO, r.r
----- L C;s 6 ,✓`^ OWNER
--
BLOCK TRACT
ADDRESS ..
N0. OF BLDGS,
SIZE OF l,O7 �- NOW ON LOT - CITY y_ » k rvrc' ,r "^
USE OF - -
BUtLpiNGS �._ -.1'% DISTRICT NO, GROUP MAP
--- - - --- --- -„�' BK PG
.CONTRACTOR
ADDRESS-`:; ;�;,. CONN'ECTiION DATA
CITY + TEL, NO. STATIONAp
' DEPTH
❑ S'"ATE MANHOLE REFERENCE ,r --
REGISTRATION NO. [_ COUNTY - --_-.__✓_ '. a
NO. DESCRIPTION OF WORK FEE`---- -- - -
_ TYPE OF CONNECTION LENGTH FROM C'
HUUSE SEWER CONNECTING TO --- "Y+ /. 'CURB _._.
PUBLIC SEvd_F.R_ ((D > 3,50 _ P.L. M.L.ML -.TOPL,- -
HOUSE SEWER CONNECTING TO
_-PRIVATE DISPOSAL SYSTEM ^-1.00 _^_- --- - - ---- --
CCR'CdECi ADDITIONAL BLDG. OR I �; P C
L , � NO.
WOR 1.G6 B",14 0.
—) ALTER OR REPAIR EXIST `G
SEKER OR DISPOSAL SYSTEM 1.0c) --- -.TRUNK PERMIT NO, ROAD PERMIT NO. _Z-�_
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT-- J
AND/OR DISPOSAL SYSTEM 1.
D_O—�fi`�_� _ PERMIT No,
SEPTIC TANK SEEPAGE PIT OR -- "-- _ - —
PITS AND/OR DRAIN IELD —� 2,00'_— INDUSTRIAL
E CESSPOOL DRYWELL--- --- WASTE APPROVAL
SPECIAL CONDITIONS ONLY _ 2.00� T� CHARGES
CONNECTION CHARGE FEE
0�1VNER"S PERMIT S t QQ --- --- —
AUTHORIZATION � TOTAL FEE - � - REIMBURSEMENT FEE �
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMIED CON- -�1� �4 T r 44
TRACTOR TO CONNECT THE ABOVE DESC IBED EXISTING DWELLING. APPROVALS DATE INSPECTOR'S SIGNATUHE�
TU THE PUBLIC SEN ,� "I I r '-- — —1 ---'— —_ --.— —
SIGNED THIS ..DAY 9F—Z71 Ig NEW HOUSE SEWER_
r
OWNER OR � � �:, :� ��•. - CONNE-C T ADDITIONAL
OWNERS AGENT BUILDING OR WORK _ a—
SEPTIC TANK,SEEP, PIT(S) I �—
ADDRE AND/OR DR�AINFIELD
I HERESY ACKNOWLEDGE THAT I O HAVE. READ THIS APPLICATION CESSPOOL❑^DRYWELL FJ
AND SY,ATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR ._
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT l AM PROPERLY REGISTERED AND/CR (_—
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR TH#T I AM THE LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RESIDEN IAL PRQPERTY,
--�.�,.� BACKFILL SEPTIC TANKS C
1 d SEEP, PITS) CI CESSPOOLS Cj
SIGNATURE *-"'a-"=,.,.-.� -OF PERMITTEE
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR