HomeMy Public PortalAbout9423 LOWER AZUSA RD_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION_
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING n
CASSATT D. GRIFFIN, SUPT of BUILDING ADDRESS �� s` 4.?t.,9
FOR APPLICANT TO FILL IN LOCALITYBUILDING NEAREST
ADDRESS - - --- -- - CROSS ST. I �q r 4� —
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
'
NEAREST �<-- ------..�--._.--.. ---- A S
d ,r
CROSS ST. ----
RECEIVED BY, Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
— — --- — ------ --- ------— I BK PG
CITY TEL.NO.
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS REQUIRED
CITY NOT REQUIRED
e LL N0.
-- -- —-. � - -- ---- -- JOB.NO.
CONNECTION CHARGE FEE
STATE ,
REGISTRATION NO. COUNTY . CO.IMP.NO. f "
LEGAL —-- RECEIPT N0. I DATE �BY
DESCRIPTION LOT N0.
BLOCK TRACT _ WAIVER FOR RECORDING
SIZE OF LOT - NO.OF BLDGS.
__ -- NOW ON LOT z RECEIPT NO. ( DATE BY
USE OF
BUILDINGS
NO. DESCRIPTION OF WOR►s;. FEE TRUNK PERMIT NO. -
—
HOUSE SEWER CONNECTING TO y ROAD PERMIT NO.
PUBLIC_ SEWER $ 3.50 +
HOUSE SEWERCONNECTING TO STATE ENCROACHMENT
-T-RI.
PVATE DiSPOSALSYSTEM 1.00 PERMIT NO.
----- -AL
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER IAO WASTE APPROVAL
ALTER 0R REAAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM_ _ 1.00 CONNECTION DATA
DISCONNECT AND ABANDON�- =
AND/OR DISPOSAL SYSTEMSTATION DEPTH
SEPTIC TANK,SEEPAGE PIT PITS AND/OR DRAINFIELD MANHOLE REFERENCE -
CESSPOOL-D RY W ELL UPPER LlDW EIt'
SPECIAL CONDITIONS ONLY 2.00 ! I� TYPE OF CONNECTION LENGTH FROM
_Y:---- CURB P_L__ M.L.TO P.L.
OWNERS PERMIT ; f 1 DO -- - ----
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 THE PUBLIC SEWER I _
SIGNED TI-;IS....-, DAY OF. _.--- -_...._ _-. 19.:...--- NEW HOUSE SEWER
l _I
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_:- __-- - _--_--------__---------- BUILDING OR WORK _
ADDRESS.. .... SEPTIC TANK,SEEP.PIT(S)
_--.---- _. _... AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS.APPLI- CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COIMILY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQU'I D BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE' DESCRIBED RESInFNTIAL PROPERTY, BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE..- ........-.-
.GA642D 663 12/52