HomeMy Public PortalAbout10410 MILOANN ST_Sewer__ DEPARTMENT OF COUNTY ENGLVFlER SEWER-SEWAGE DISPOSAL. 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING � I —
ADDRESS
FOR APPLICANT TO FILL IN �r�� LOCALITY
BUILDING `T /� J N` \ ST Orf(
ADORHSS CROSS CROSS ST.
LOCALITY WSTRICT NO. SERIAL NO. PERMIT NO.
NEAREST —.._ :' A 4� � J
CROSS ST. - -- —
�rw RECEIVED BY Ready for Inspection DATE ISS ED
OWNER /
MAIL
ADDRESS USE ZONE I OCCUPANCY B M* ps
CITY TEL.NO.
CONTRACTOR /
r" CO.IMP.N0. �' �� •._.Xy�' s}?
� A r
ADDRESS Y
r JOB.NO.
CITY +� � TEL.NOTRUNK PERMIT NO.
7 p�� STATE —
REGISTRATION NO. ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT-----� ------
DESCRIPTION LOT N0. _ PERMIT NO.
BLOCK TRACT INDUSTRIAL "
WASTE APPROVAL
SIZE OF LOT NO.OF f 'tit S
NOW ON LOTCHARGES
USE O '4BUILDINGS `; �� CONNECTION CHARGE FEE
NO. DE CRIPTION OF W RK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER_ @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CON ECTING TO
PRIVATE DISPOSAL SYSTEM 1.00_
CONNECT ADDITIONAL BLDG.OR EXC PTION RECORDED
_WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING f'0 `. DATE 13Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM I.00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATIONS s t ,tf" DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER
TYPE OF CONNECTION LENGTH FROM t '%
Y:. CURB P.L. M.L.TO P.L.
.._-
OWNERS PERMIT s 1 00
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 TU 131LIC SEWER
SIGNED THIS.--1% ..DAY � _-._I�'!-y NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
....
BUILDING OR WORK
OWNERS AGENT- _. -f.-_-. "'- SEPTIC TANK,SEEP.PIT($)
ADORES S...............-.............-....-.. - ....................... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LNGELES COUNTY ABANDON HOUSE SEWER
OS
AND STATE OF CALIFORNIA OR THAT I M E GAL OWN-
ER OF THE ABOVE DESCRIBED RESID ERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPO Ste
OF PERMITTEE----
76A642A 663 7/53 /