HomeMy Public PortalAbout9411 LOWER AZUSA RD_Sewer__ r6AE-66 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
,. r--lbunty of Los Angeles BUILDING r :'
J6HN A, LAMBIE, COUNTY ENGINEER A)DRESS� 1�_ � k T. i�— < �
u CASSATT D. GRIFFIN, SUP'Y OF Swl,.OiNG LOCALITY �
NcAREST
FOR APPLICANT TO FILL IN cRoss ST :_
LEGAL
_eESCRIPTION L07 NO. --.___---�----___.-- OANER
-_... _— ---- MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS.
SIZE OF LOT - NOW ON LOT C TY TEL. NO.
USE OF ^_ _ _ - -
BUTLDING5 v DISTRICT N0. GROUP IAP
CONTRA TOR;
CONNECTION DATA
ADDRESS
-- "r; - - '�---.- -,--, MANHOLE RE 1'
SAION AT _�..._ DE
CITY \t( TEL NO. — — —
y REFERENCE ,rWpEg--
i 0—§TATE _ r' LOWER
REGISTRATION i'J0 COUNTY
NO. DESCRIPTION ''OF WOF(C FEE ---- —'--- —
TYPE F.CtibUk FET10N.
_ LENGTH
_PFR_LO.
M E�ER R13 P.L. R. TOPUBLICS
— —
—
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFiLL:D Cry $3.07
- --- -` -— - ---- I------
OVERFLOW SEEPAGE.PIT, DRAINFIELD P. C. NO.
E'NTN.-,CES$FCOL,DRYWELL.'A ANHOLE i% $2.Do-I i C), IIP. NO- a >' 7� r� 10B NO,
H( U E SEWER CONNECTING 70 ;PRIVATE DISPOSAL SYSTEM �a o__T.O. 7r,UNK PERMIT NO. ROAD PERMIT N0,
! CONNECT ADDITIONAL BLDG,UR j ! - STATE ENCROACHMENT
I
WORK'TO HOUSE SEWER Ct S 1.00 PERMIT"d0.
ALTER,REPA R OR ABANDON HOUSE INDUSTRIAL
! SEVER OR D SPOS.i SYSTEM $1.0,-
WASTE APPROVAL
CHARGES
---I— --- __.__ ..._-- ----- -- ----
.�
CONNECTION CHARGE FEE
OWNER'S PERMIT_ � ! 1 00 --- — ------—�. - —._O V XAIa
.—
AUTHORIvATION TOTAL FEE p-< I- I — PaIHIBURwE:vl EstT;FrEpgE
DATE INSPECTOR S S CZNA.TURE
I HAVE AT THIS UATL. A CONTRACT WITH TIE 0,EREIN NAMED CON- .--_.--..—_APPRPR —___.._. . _�__—_--- i -
-__.._
TRACTOR T.] CQNNEC? THE ABOVE DkSCR BED EY,TSTING D',.tLLIN'G
TO THE Pi SLID SEWER NEW HOUSE SEWER -
SIGNED THIS C`AY OF }.�.,T' ,.,- _ _:_'9. CONNECT ADDITIONAL ------
OWN-ER GP ,;.�__,� i BUILDING OR Y C K
OWNERS AGFN z_ .�'�.. ....> �.i_ _ SEPTIC
E SE, TANK P --- --1-- -- I --._ —.--
PIT(S)
AND/GR GRAINFIELD --
! H REBY ACKNOWLEDGETHAT HAVE AD THIS APPLICATION CE5S'P00L LL DR"IELL� �
AND STATE T'r T TETE ABOVE iS C RRECT AND .AGREE O, COMPLY —..
WHTH, ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SE,.ER OR j ---
PLUMBING AND SEV I]RS, —5k-WAGE DISPOSAL SYSTEM _I
I HEREBY CLR-t1Y THAI' I nM PROPERLY REGISTERED AND/OR DISCO h NECTP UG AND ------
WER
P,..0 4D9'"RERNIA �7H 7, eRO �}7} LEw AL NSR OFrrTI Ai3C YE f BACKFILL SEPTIC TANKS
---- —` ---
LICENSED AS k O a-D BY 1.`1S AN (- CO JNTY A.N 5I TE FOUSE I
1 '� E ,G ! .spa SEEP. i iT(S, OEs-SPOOLS ----
°OF PER MiTT`EE - - -) -
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIO.W J ROBERT A.WOOD, CiAIEE'PLBG. iNSPFC-QR
CASH