HomeMy Public PortalAbout9412 LOWER AZUSA RD_Sewer__ DEPAHLTBESNT OF COIIN= ENGEv1E= SEWER-SEWAGE DISPOSAL
DIVIeSTiON OF BUILDING AND SAFETY PERMIT APPLICATION
CO®NN7L"S OF LOS ANG LW BUILDING 1 }�
WILLIAM J. FOX. COUNTY ENGINEER I ADDRESS qL�.1`,� •{�C1l��P!- (-�.ZV5c3.
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS �{ CROSS ST. 1 n
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
GY .. _
NEAREST. IC, )0 "_� j� ` G� C
ECEIVED BY Ready for Inapeotlen DATE ISSUED
OWNER
MAIL
ADDRE USE ZONE OCCUPANCY BK MAP INS
CITY I
1�& .. TEL.NO. A -1
I I
CONTRACTOR U.P ,
CO.IMP.NO. 1. Cp— 2—C
ADDRESS _t_t —g JOB.NO.
CITY„ TELAO. TRUNK PERMIT N0.
STATE
REGISTRATION N0. COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. 1QZZ cN 2a , STATE ENCROACHMENT --�
PERMIT N0.
BLOCK TRACT S__,_rA,r rpn R9 V L4y INDUSTRIAL
ASTE APPROVAL
812E OF LOT / D D NOW ON LOTCHARGES
S
USE OF CONNECTIO ARGE FEE
BUILDINGS �� �+
NO. DESORIPTION OF WOR�, FEE REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLICSEWER $ 8.50 RECEIPT N0. ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT
OR DISPOSAL YSTEM SEWER
A 1,00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 111 OLE REFERENCE
UPPER LOWER
�Y F CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 CURQ P.L. M.L.TO P.L.
AA
AUTHORIZATION TOTAL FEE I Z G
CONTRACTOR DATE
O CONNECT CONTRACTED
ABOVE THE HEREIN
EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _�LDAY OF_ -)qS 4- NEW HOUSE SEWER s'
CONNECT ADDITIONAL
OWNER OR ,�,, // . BUILDING OR WORK
OWNERS AGE
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.....................���-_.._. ..—.---.�.—.._.._.—__.. _. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES RESTLAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE-SEWER
AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABO DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE , _ SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE. _ ,.�[._..... ` L.�•L!���•�= .._.
aasadge aaa z/rs
DEP"rXCEN'd OF COUNTY ENGENEER SEWER-SEWAGE DISPOSAL 1
DIVLSMN OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS �% �• G� .,-_.s 3 J. j
FOR APPLICANT TO FILL IN LOCALITY ;
ADDRESS L CROSS ST.
LOCALITY A/V L �4 E C! DISTRICT-1110. SERIAL NO. PERMIT NO.
NEAREST ��� ��'" ® r� S
CROSS ST. �� a
RECEIVED_SY Ready for Inspection D TE ISSUED
OWNER / Q, /� r- _ �C. � J S �✓�a `_'
MAIL '4M y i'�1'1
ADDRESS /T6 AA3o V JE_ `USE ZONE'^} OCCUPANCY BK MAP PG
CITY TEL.NO. I J'--?L�` r9
I m�
CONTRACTOR ���I F ��� ���A CO.IMP.N0.
vQJ('
ADDRESS JOB NO.
CITY TEL.N0. ! 5a TRUNK PERMIT NO. - - -_� -_-- --_
•y _
REGISTRATION NO. STATE DAD PERMIT NO.
LEGAL / a
DESCRIPTION LOT N0. V[J STATE ENCROACHMENT - ----__ r ,
PERMIT NO.
BLOCK TRACT - INDUSTRIAL
.
WASTE APPROVAL '-
SIZE OF LOTNO.OF BLDGS.
ItNOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE F
NO. DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
V PUBLIC SEWER 0$ $ 3.50 RECEIPT NO. I ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEP ION CORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DA 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 p
SESSPOOL-DRYWELL DEPTH
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE
�r�
�S (i,0 4-�'Es LOWS
- TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ , I 0 Y. e'er- Lr-p M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 51
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE ESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO LIC SEWER
SIGNED THIS -DAY OF. ... _..._.19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL r.
OWNERS AGEN .._ _.._.._. ._......_..�._......_. .._ BUILDING OR WORK
.............. SEPTIC TANK,SEEP.PIT(S)
ADDRESS
• •••. • ••••• • . - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYW.ELL❑
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 DISCONNECT PLUG AND
AND LICENSED AS REQUIRE BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFOR AOR AM THE LEGAL OWN-
ER OF THE AB ES IBE DIRNTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
IT(S)[] CESSPOOLS
OF PERMITTEE _.. _.. ....._.._ _.._ _ ......�._.._
7GA042D 663 1/53