HomeMy Public PortalAbout10626 LYNROSE ST_Sewer__ DEPART-NfENT OF COUNTY ENGTA'EER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY Or LOS ANGELES
WILLIAM J. FOX, BUILDING
COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY-:::t--
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST ,. A �C{
CROSS ST. _ ECEIVED BY Ready for Inspection DATEISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY BK MAP PG
-�
CITY TELAO. _j.-._ -
CONTRACTOR #MP
ADDRESS JOB.NO.
CITY z `R, TEL.NO. TRUNK PERMIT NO.
REGISTRATION N0. STATE
COUNTY ROAD PERMIT NO. --
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. C f 4 _ PERMIT NO. -
BLOCK TRACT, p 1f36 'NDUSTRIAL
'•' '" WASTE APPROVAL f....-
NO.OF BLDGS.
SIZE OF LOT ��' NOW ON LOT CHARGES
USE OF
BUILDINGS ,. CONNECTM! CHARGE FEE
NO. DESCRIPTION OF WORK FEE �
4
HOUSE SEWER CONNECTING 70 REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. I j I BY
HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR '" XCEPTION RECORDE
__WORK TO HOUSE SEWER 1.00 -
ALTER OR REPAIR EXISTING NO. I DATE I BY
__SEWER OR DISPOSAL SYSTEM 1.00
OISCONNEC7 AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR _
_PITS AND/OR DRAINFIELD 2.00 STATIONDEPTH rr
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER
TYPE
$
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00
Y. „^. *: M.L.To P.L.
AUTHORIZATION I TOTAL FEEIHAVE THIS DATE CONTRACI —
NAED
CONTRACTOR TO CONNECT TH7E ED ABOVE DESCRIBEDWITH THEI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF............_.............._..........19-_.. NEW HOUSE SEWER 5 'jk.
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........._......_......_. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS......................_...._............................................................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE, ESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS E]
SIGNATURE 3t l - J' �/, SEEP.PIT(S)❑ CESSPOOLS
OF PERMITTEE--- .. a'._.._....................................
76A642A 663 5/53 -