HomeMy Public PortalAbout9079-9081-9083 LYLEDALE ST_Sewer__ DEPART311ENT OF COUNTY ENGI TF.ERk SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND AFETY PERMIT`APPLICATION
COUNTY OF LOS ANGELES ? p
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
1 ADDRESS
FOR APPLICANT TO FILL IN I Locau7v ". _
BUILDING NEAREST f
ADDRESS Q �� CROSS ST.
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY A ' / /�
NEAREST S A �/ GA y! C
CROSS ST. .
RECE.I�VE�Dy�BY Ready for Inspection DATEISSUED
OWNER ( Ll ( min ' --G� � � /Yl I /"'•�
MAiOCCUPANCY MAP
ADDRESS. USE ZONE p�d'U �e 4 ��� / f BK PG
CITY / TEL„N0.
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CONTRACTOR. Cc Nottingham Co.-of Temple Cil
CO.IMP.NO. �
ADDRESS 8933 N. CLOVERLY AVE:
JOB.NO. �`� �
CITY fiMPL Tff O.CALIF.
TRUNK PERMIT NO.
REGISTRATION NO. A OUNTY ROAD PERMIT NO. .
LEGAL ° f STATE ENCROACHMENT
DESCRIPTION LOT N0. ZO PERMIT NO.
BLOCK TRACT ' INDUSTRIAL
WASTE APPROVAL
SIZE OF LCT W ON LOTS 1 CHARGES
USE OF
BUILDINGS J(. � CONNECTIOWCHA'RGE-•FEE. �+
No. DESCR TION OF WORK FEE
HOUSE SEWTR CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @_I 3.50 RECEIPT NO. I �' DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR 1 EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 `
ALTER OR REPAIR EXISTING NO' ( f DATE 3 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 � s_f DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ?/ / MANHOLE REFERENCE
UPPER
TYPE OF CONNECTION LENGTH FROM
LY__ OWIR P.L. M.L.TO P.L-
OWNERS PERMIT $ I 1 00
AUTHORIZATION' ( TOTAL FEE 44 -
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING • APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNERT 70 THE PUBLIC SEWER 19'x– CONNECT E SEWER 4
SIGNED'THIS.____ .._._._ _ Y OF_
OWNERS OWNER
OGE BUILDING OR WORK
_ SEPTIC TANK,SEEP.PIT(S)
ADDRESS __ �? GF /-,N? __. !_ _y_'�. .:. ' AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI•11 CESSPOOL I] DRYWELL
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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED} DISCONNECTPLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY. ABANDON HOPLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-1
ER OF THE ABOVE DESCRIBED HE ITIAL PROPERTY. BACKFILL SEPTIC TANKS❑
,�y� . SEEP.PIT,(S)Cj CESSPOOLS[D
SIGNATURE AWL ..
OF PERMITTEE--__ .
76A642A 663 .7/53' /'� _