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HomeMy Public PortalAbout9861 LOWER AZUSA RD_Sewer__ DEPARTMENT OF COUNTY ENGINEER, SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FDX, COUNTY ENGINEER BUILDING ADDRESS p FORPLIC T TO FILL IN LOCALITY BUILDING RREST ADDRESS / E83T. r, LOCALITY ' DISTRICT N0. ERIAL NO. PERMIT NO. c NEAREST A �S0 8 —J CROSS ST. .• R CEIYED BY Ready for Inspection DATE ISSUED OWNEROF �s- MAIL USEZONW OCCUPANCY MAP ADDRESS 4ftBK PG CIT TEL.NO CONTRACTOR CO.IMP.NO, ADDRESS ' JOB N0. CITY TEL.NO. TRUNK PERMIT NO. REGISTRATION NO. �7G 17-jC-ys SNIw ROAD PERMIT NO. � LEGAL =--t q�p7 ea— N'i 6 STATE ENCROACHMENT DESCRIPTION LOT NO1-i�c- -�V W R� .�1\T PERMIT NO. BLOCK TRACT L l �� F5 I Al1STRIAL ^' al A�QE APPROVAL B NO.OF BLOGS. SIZE OF LOT Z IJ( Z, NOW ON LOT / CHARGES BUILDINGS /�J CTION CHAR E NO. DESCRIPTI13N OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER 0 $ 3.50 RECEIPT NO. TE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR / EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO I DATE I 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 '�` © DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 I MA LE REFERENCE LOWER TYPE OF CONNECT LENGTH FROM ,� I OWNERS PERMIT I 00 "'u P. M.L. 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 SIGNED THIS_j_l.....DAY OF_.J4r1 ,,�__.19_lr+ NEW HOUSE SEWER 4 OWNER OR �f CONNECT ADDITIONAL OWNERS AGENT.iI� BUILDING OR WORK --- — SEPTIC TANKSEEP. ADDRESS?l AND/OR DRAINFIELD PIT(S) 1 HEREBY ACKNOWLEDGE T 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL CATION AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP.PIT(S)[] CESSPOOLS OF PERMITTE ___k ___ i t. r i` 70A642A 663 7/53 IL T�