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HomeMy Public PortalAbout10620 LYNROSE ST_Sewer__ ow-JOA Exanv>Im SEWER—SEWAGE DISPOSAL 41 IVISION BUILDING AND SAFETY PERMIT APPLICATION CO OF LOS Al GRIMS NG WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS O r (Q © I.rAw ;•1 "� lcilQ� FOR APPLICANT TO F LL IN LOCALITY BUILDINNEAREST ) I .__� �• ADDRESS (�/ I��® CROSS ST. LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO. Af A—A c� NEAREST V -�� A � ` `• ° •�� J CROSS ST. RE5EIVED BY r) Ready for Inspection DATE ISSUED OWNER MAIL ADORES PG USE ZONE OCCUPANCY BK CITYTELIIO. I � CONTRACTOR I i CO..IMP.NO. ADDRESS JOB.NO. A CITY �J[ g TELNO. ,i �5, TRUNK PERMIT N0. - -- - -_ STATE REBISTRATIO ® COUNTY ROAD PERMIT NO. LEGAL STATE ENCROACHMENT`+ DESCRIPTION PERMIT NO.IF - BLOCK TRACT n f ~` INDUSTRIAL _ WASTE APPROVAL - ----� 812E OF LOT NO.OF BLDGS. z CHARGES NOW ON LOT USE OF BUILDINGS CONNECTION CHARGh�FEE NO. DESCRIPTION OF ORK FEE REIMBURSEMENT FEE N HOUSE SEWER CONNECTI TO PUBLIC SEWER ! $ 3.50 RECEIPT N0. I DRAT I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTy o RECORDED WORK TO HOUSE SEWER 1.00 NO. ALTER OR REPAIR EXISTING DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 AND/OR DISPOSAL SYSTEM SEWER 1,00 e�a l,'-P•^CONNECTION DATA SEPTIC ITS AND/on'SEEPAGE PIT OR 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 - �� �� MANUPPER EFERENCE -b0 yme TYPE OF CONNECTION LENGTH FROM Y. .688111s.P-L-. M.L.TO P.L. OWNERS PERMIT ¢ I 00 AUTHORIZATION I TOTAL FEE 1 HAVE THIS DATE CONTRACTED WI THE HEREIN NAMED CONTRACTOR TOC NNECT THE ABO DESCRIBED EXI8TIN8 APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING T PUBLIC SEWER SIGNED TH DAY OF_ I NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGEq BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS.__..___._.._._..___.._...._..__.; _.._..._ _ .. __ AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL I] CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL LINTY ORDINANCE8 AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PD SEWERS. SEWAGE DISPOSAL SYSTEM 1 HE NiCE IFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUS AND AND/OR LICED REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE 0 CAL ORNIA OR THAT 1 M THE LEGAL OWN- ER OF THE A OV ESCRI D REST, IAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE r o SEEP.PIT(S)[] CESSPOOLS[] OF PERMITTEE..._. ........... 76A642A 663 7/53 ��