HomeMy Public PortalAbout10213 NADINE ST_Sewer__ DEPA191AIMT OF COUNTY ENtf�nvE M SEWE"EWAGE DISPOSAL , 9 3 8 1
D*ISION OF BUILDING AND SAFETY i PERMIT APPLICATION
c OOUNTY OF LOS ANGELES
WILLIAM J FOX COYNTY ENBINEERBUILDING
ADDRESS O l
FOR APP CANT TO FILL IN LOCALITY
BUILD N8 KEA v /� -
ADDRESS CROSS ST AilA.
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEARESTSr A O Q 1�O S
CROSS ST ► ►
E VED BY Ready for lasoeall" DATE ISSUED
OWNER f - S,3
MAIL USE ZONE OCCUPANCY 1 BK MAP PG
CITY TEL NO
CONTRACTOIVaj3_%0=ja SOWB_ e__ _ CO IMP NO
ADDRESS
Y�17 JOB No
CITY TEL N I TRUNK PERMIT NO
E
RE STRATION NO COUNTY ROAD PERMIT NO
L GAL
DESCRIPTION LOT NO
STATE ENC NOROACHMENT
BLOCK TRACT A'S 644 c% INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT�� J&D NOW ON LOT8 CHARGES -
USE OF
BUILDINGSCONNECTION CH RBE FEE
NO DEBCRIPYION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT F
PUBLIC SEWER all 350 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDIONAL WORK TO HOUSE SEWER LOS OR 100 EXCEPTI&kRKCORDED
ALTER OR REPAIR EXISTING NO t BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISTARPOSAL SYSTEM 100 CONNECTION DA
SEPTTS AND/OR GRAINFIELDEIPAGE 200
OR ERI f
CESSPOOL—DRYWELL STATION f ► DEPTH
SPECIAL CONDITIONS ONLY ERI /6.3 UPPEREFERENCE L
TYPE OF CCOOINSNE P L i L L TO P L OM
OWNERS PERMIT ; 1 00 '__
AUTHORIZATION TOTAL FEE 25'
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TOyyTHE��PUBLIC SEWER _ Q
SIGNED THISS.4/_—DAY OF _I/9�--'r���_" 1� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING OR WORK
SL DORDRANFLIT(S)
ADDRESS OQa a _ _ AN% IIED
I 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
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTYi ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE ABOVE DESCR ED R IDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SEEP PIT(S)� CESSPOOL SG r 5L
OF PERKITTE� ' _ ► _ --