HomeMy Public PortalAbout10627 LYNROSE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SENDER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, BUILDING
COUNTY ENDINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY 7,
BUILDING / ] 1- NEAREST
—, CROSS ST. '
LOCALITY �, / 1L� DISTRICT NO. SERIAL NO. PERMIT NO.
_ r
cNRlisssr..-'L ��Ii1 -4- 'ss /�C< A w_d f`j zi $
�.__,( ,,//� RECEIVED BY Ready for Inspection DAVE ISSUED
OWNER Ll • 1, t V/�- 3' L
_
MAIL
7� (!52L4 ��s USE ZONEOCCUPANCY BKym*10-PG
CITY
CONTRACTOR -.72 / /l
CO.IMP.NO.
ADDRESS JOB.NO. y /
CITY ) 1,-TEL.NO, i ^ -7-3% J TRUNK PERMIT NO.FF
—
REGISTRATION NO. i COUATE NTY ROAD PERMIT NO. —�
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT�(j7r /C� �
_PERMIT N0.
BLOCK TRACT INDUSTRIAL
WASTEAPPROVAL
SIZE OFLOT , ) N0. OOF BLDGS.
r NOW N LOT CHARGES
BUILDINGS � � `h�� /41 Z'-USEOF CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
/ HOUSE SEWER CONNECTING TO —
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE HEWER CONNECTING TO
_ PRWATE DISPOSAL SYSTEM 1.00
CONNECTADDITIONALBLDG.OR E CEPTIOMRECORDED
WORK TO HOUSE SEWER 1.00 N
ALTER OR REPAIR EXISTING DATE 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 L_ STATION 7- DEPTH
CESSPOOL—DRYWELL
SPEC!AL CONWTIONS ONLY 2.00 __ -7. f I M NHOLE REFERENC�
/ _UPPER: -.LCYifp-
i
! `STYPE OF CONNECTION LENGTH FROM
Y. M.L.TO P.L.
OWNERS PERMIT $ I I 00 # ya
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 r
SIGNED THIS---r1.--------..-DAY OF_( NEW HOUSE SEWER
OWNER OR (,_/ / CONNECT ADDITIONAL
1 7
BUILDING OR WORK
S
OWNERS AGENT . C�4�'.�
ADDRESS.---..-----. :__ `'S ..G-.... __•-/•1�1
SEPTIC TANK,SEEP.PIT(S)
-._._-.. ..-.... AND/OR DRAINFIELD
! HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL F] DRYWELL I]
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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/CSR L'CENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED,.RESIDENTIAL PROPERTY. #/ BACKFILL SEPTIC TANKS E]
SIGNATURE SEEP.PIT(S)D CESSPOOLS[]
OF PERMITTEE.._
'(6A642D 663 1/53