HomeMy Public PortalAbout10209 NADINE ST_Sewer__ >ey�rA>lrrINT OF COUNTY ENGENEER SEWER—SEWAGE DISPOSAL
+DIVISION OF BUMDING AND SAFETY PERMIT APPLICATION 9 1 1
COUNTY OF LOS ANGICUM
WILLIAM J FOX COUNTY ENGINEER �I ILDING
ADDRESS IOZOY >C $T
FOR APP ICANT O FILL IN LOCALITY
ADDRE NEAREST
CROSS ST a!C Q
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST 4 A Q S
CRO85 t REECE!jIIVEE Ready for Iatpeetles DATE ISSUED
OWNER ar g
MAIL
ADORE USE ZONE OCCUPANCY BK MAP PB
CITY TEL NO A— I �C'$
CONTRACTOR C$1irornl8 SAwsr CO IMP NQ /
ADDRESS 1517 COleg A\TA AVO- JOB NO
--
CITY AIO=ltebe110 TEL 111011M on TRUNK PERMIT NO
REGIATION NO 10444 LINTY ROAD PERMIT NO
DESCRIPTION LOT NO e2•��- L?�G�SD STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT pL INDUSTRIAL
SIZE OF LOT�� NOW ON LOTS WASTE APPROVAL
CHAR096
USE OF
BUILDINGS CONNECTION CH 8E FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FE
PUBLICSEWER ! $ 880 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR E EPTION ECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO DAT (BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER CONNECTION DATA
AND/OR DISPOSAL SYSTEM foe
SEPTIC TANKSEEPAGE PIT OR _
PITS AND/OR GRAINFIELD 2.00 STATION 'S �- D DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 �N EFERENCE
FUPJPE C_OIPg
C
E OF �ECTIO LLL FROM
OWNERS PERMIT ; 1 00l � P TO .Z-
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
iEN 40WO
SIGNED THIS ._. DAY OF _19— [ALTER
EW HOUSE SEWER tv,V� �� TO 3
OWNER OR J ONNECT ADDITIONAL
ONE
AGE4.?
�A.1_ _ _ UILDING OR WORK
ADDRESS Nt1%ORDRAINFIELOIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS EWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTEREDISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTYAND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNBANDON HOUSE SEWER
ER OF THE ABOVE DEBC IBED ESIDENTIAL PROPS ACKFILL SEPTIC TANKS nEEP PIT(8) CESSPOOL$ /f
SIGNATURE
OF PERMITTE
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