HomeMy Public PortalAbout9561 LOWER AZUSA RD_Sewer__ DF.PARTMF.NT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES ///���.., rr
WILLIAM J. FOX, COUNTY ENGINEER BUILDING y ��
ADDRE88 /
FOR APPLICAPT TOFILL IN LOCALITY 7 g h4 oo p '
BUILDING NEAREST
ADDRESS CROSS ST r v
LOCALITY DISTRI 0ERIAL NO _ O
NEAREST f A �,C��••j 666
CROSS 8T
ED BY Ready for Inspection DA RUED
OWNER ��
MAIL USE ZON I OCCUPANCY �K MA _
ADDRESS �AP\
CITY TEL NO /y
CONTRACTOR �. cy 91 5LD//?��/ CO.IMP N0.
ADDRESS z J c 4 Z /01,/. JQ (/rOJ. JOB.NO
CITY s S C TEL NO./4-7' CX4-77 Z TRUNK PERMIT NO
REGISTRATION NO 9 ` �J C4Z 8 JCOUNTY ROAD PERMIT NOLEGAL
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DESCRIPTION LOT NO �^ 3 Z G —3 r;z" STATE ENCROACHMENT
$c a o PERMIT NO
BLOCK TRACTk ^ (� 41 6 77
q— .�� INDUSTRIAL
L WASTE APPROVAL
SIZE OF LOTS-3,X ) Lr NOW ON LOTS CHARGES
USE OF
BUILDINGS CONNECTION CH FEE
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER a $ 850 RECEIPT NO AT I BY
HOUSE SEWER CONNECTING TO 0.1
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG ORXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM loo
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR �`j f-j
PITS AND/OR DRAINFIELD 200 STATION -t' w DEPTH
CESSPOOL—DRYWELL / M "WFSPECIAL CONDITIONS ONLY 200 U ER
TYPE OF CONNE LENGTH FROM /
Y CURB PL ML TOPL
OWNERSPERMIT ; I 00
AUTHORIZATION TOTAL FEE
WITH THE HEREINAMED
CONTRACTOIR TO CONN CT THDATETE ABOVE DESCRIBED ED EXISTIING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS Y OF I NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS A NT _ BUILDING OR WORK
ADDRESS AEPTIC ND/OR DRAINF SEEPELD IT(8)
1 HEREB ACKNOWLEDGE THAT 1 HAV READ THIS APPLI. CESSPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE I 1 ORRECT 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 1 AM PROPERLY REGISTERED' DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRI ED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE �i� SEEP PIT(S)[] CESSPOOLS Z
OF PERMITTEE
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