HomeMy Public PortalAbout9515 LOWER AZUSA RD_Sewer__ r° 642D APPLICATION FOR PERMIT 1
i B E-Efi3 f9.5G
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Deportment of County Engineer
County of Los Angeles BUILDING r
ADDRESS
JOHN A. LAIvtB1E, COUNTY E?vG?[a€E� ---
'_—
CASSATT D. GRIFFIN, S0a'T of BUILDING LOCALITY � �✓ ,a; > '_.r ✓ c'
NEAREST ✓";
_ FOR APPLICANT TO FILL IN CROSS STS. ,.�� ;l f'.1;
ID
L€GAESCRIPTION LOT NO -- �"'J'-'. - ' .,"�; L.� OWNER j_ MAILLOCK TRACT ! -✓ e °Y=' ' ADDR€SS
` L ---
NO.OF BLDG$.
SE OF LOTt";`,; NOW ON LOTS CITY TEL. N0.
IZ
USE OF
BUILDINGS yj_-y''� �;' S r '4a�y --� DISTRICT NO. i GROUP 1 MAP
— � I SK PG
CONTRACTOR_1-</- _ ,/'.° .,�- _ '.•'` 4' a::
— CONNECTION DATA
ADDRESS `�e ��� ✓ — -- — - - -
/', �' ":..TEL. NO.,s:.a`.r' STATION w '°' —DEPTH
CIT
MANHOL.€REFERENCE
STATE ✓ `
REGISTRATION X10 - '' .'..i-„rr ,�,. (�, COU7 TY ®.
NO. i DESCRIPTION OF WOPK FEE --- -
- — --- - -- TYPE 0 ^TION LENGTH FROM
SEWER
—
HOUSE SEErc CONNECTING Ti. -- Y. G,uR P,L. LEN TF L, y�
_PUBLIC SEK E4 _ C� s.3_SJ �' > J — ------' �� — --
-� --- _
SEPTIC TANS:,SEEPAGE PIT OR - I
PITS ANDiOR DRAINFIELD (7 >.00
OVERFLOW SEEPAGE PIT DRASP Fte.LC P C NO..
1 E`( NCESSPOOI,DR"WEL.L.i7AN iGLE to 4.00-
HOU`,”.SEWER C()NNr TING TO
PRIVATE DISPOSAL SYSTEM 01 4 1.0(, V TRUNK PERMIT NO. - ROAD PERMIT NO.7
CONNECT ADDII ION AL BLDG.OR ---- STATE ENCROACHMENT
SVORK TO HOUSE SEWER tr S 1.01 P€RleilT NO,
ALTER,REPAIR OR ABANDON HOUSE T-- — -`- - --------- ------------.A—_
EWER OR DISPOSAL YS�EN I. INDUSTRIAL
,_ - � � WASTE APPROVAL
j - CHARGE'S
i
CONNECTION CHARGE FEE .
OWNER'S PERMITS 1 C10 -
--�_ -- ---- -- -- --- -- - --
�
rt -- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 1 I
I HAVE AT THIS DA'T'E .A CONTRACT WiTEi THE HEREIN NAMED CON- APPROVALS
� DATE 1tiSPEC:CR�Ss!GNArUIiE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING D',1VELLiNG
-------------------- _.ATE ;NNSPEC.-___----------
TO THE PUBLIC i 4. NEW HOUSE SEWER -
SIGNED TrOS, ---'� ` DAY OF
-:-'—
CONNECT ADDITIONAL. -
OWNER ORL� BUILDING OR WORK. — ---�--- _--
01-iNERS AGENT b".'
-.. SEPTIC TANK,SEEP,PIT ISI
ADDRESS- AND/ORDRAINFIELD
g.
FFREST ACKNOWLEDGE THAT I HAVE READ THS APPLICATION � .
AND STATE C;.. CCSSPOOLL7 DRY WELLi� j
snt „c3GVE !S CORRECT AND A.GFkE TO COMPLY .-__ _—_- —_.---.____..__7._----_-�—_---_"- -----
'r_1H ATL COUNTY ORDINANCES AND STATE LAV.S REGULATING ALTER,REPAIR,SEWER OR
PLU14BING AND S VVFRS. S€'WAGE DISPOSAL SYSTEM
—.J_—
1 HERESY CRE.,FY THAT ! A.St PROPERLY REGISTERED END/OF DISCONNECT PLUG AND. I
CALIFORNIA
A REO HAFD BY LOS ANGELESGAL COUNTY F E ATF OF ABANDON HOUSE SEWY R
CALIFORNIA OR THAT t AN THE LEGAL OWNER Or THE ABOVE --.. -_....- -_'— -.._i..__.__,__..__,—.—_.,__._._._
R,L-PROPERTY, �, _. SEEP._P11(S).D CESSPOOLS f 7
OF PERMITTEE .✓r.` -1
DESCRIBED R.E�IDENTI L 'iY E3A^Kt ILL SEPTIC TANKS El
SI
[OHN A. LAIABIE,COUNTY ENGINEERVALIDri.srnlOty ROBERT A. WOOD. CHIEF PLBG. INPECTOR
N -S
M.O. CASH
r
�
j! n .La .r. 4 w 3 s`.