HomeMy Public PortalAbout9837 MILOANN ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT.TO FILL IN LOCALITY
BUILDING 'e" f? NEAREST
ADDRESS J � ter--"
CROSS ST.
LOCALITY �Zy `^ DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. R
y^� RECEIVED BY Ready for Inspection DATE ISSUED
OWNER s C.6 !I
ADORES 3., � USE ZONE OCCUPANCY BKMAP
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CITY - TEL.NO.
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CONTRAOTOR 14,
CO.IMP.NO.
ADDRESS JOB.NO.
CITY EL.NO. 'yLJ _ TRUNK PERMIT NO.
9�7/Z/ STATE
REGISTRATION 40. + COUNTY ROAD PERMIT NO.
LEGAL �ti —
DESCRIPTION LOT NO. STATE ENCROACHMENT -
PERMIT NO.
BLOCK TRACT �2- � INDUSTRIAL
rJ' NOW ON LOT CHARGES
SIZE OF LOT 'o J� N0.OF BLOCS. WASTE APPROVAL
USE OF
BUILDINGS �!��" r� `✓. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK '.*IEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER (g3 ; 3.50 RECEIPT NO. DATE I BY
--
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
OONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE (BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABAkDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRYWELL
f SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
iUPPER LOWER
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT j ` 1 00
AUTHORIZATION TOTAL FEE I -
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
NEW HOUSE SEWER
SIGNED THIS-----1. ......DAY OF__.___s .[� .........-----19-3- _
OWNER OR w O k CONNECT ADDITIONAL
OWNERS AGENTy YCk ._ - v �a _1 �•'`�-�.._ BUILDING OR WORK
d1J' SEPTIC TANK,SEEP.PIT(S)
ADDRESS ` ,.5 -- ?i Wit---. ..._ 4 �. AND/OR 0RAiNF1ELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED 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
SEEP.PIT(S)E] CESSPOOLS
SIGNATURE
OF PERMITTEE ----_._.`.......•----------------- -- '--.....:.. ..............._.....--
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