HomeMy Public PortalAbout10218 NADINE ST_Sewer__ t
DE PASTAECATT OF COUNTY ENGDFZMM SEWER-SEWAGE DISPOSAL
DMSION OF BUMMIG AND SAFETY j PERMIT APPLICATION 9451
COUNTY OF LOS "GELEB
WILLIAM J FOXr COUNTY ENGINEER ADD ESS I
t
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FOR APPL C NT TO LL IN LOCALITY
ILDING/oa
ADDRESS GROSS ST
LOCALITY DISTRICT NO SERIAL NO PERMIT NO c
NEAREST A l O o L $
CROSS ST • /
IVED BY Ready for Ioe0eolfm DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
OGRESS BK PB
CITY TEL.NO —/
CONTRACTOR ; CD
�1 �� � CO IMP NO
ADDRESS ! �J JOB NO
CITY L NO 6414 ISP48 TRUNK PERMIT NO
STATE
REGISTRATION 1101B COUNTY ROAD PERMIT NO
DESCRIPTION LOT NO LQ ,8-31ok D I STATE ENCROACHMENT -�s
PERMIT NO
BLOCK TRACT�.��g '� ' INDUSTRIALWASPOVAL
SIZE OF LOT,,,Ir& x ! NOW ON LOT8 - CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FE
NO DESCRIPTION OF WORK FEE {
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER i 330 �i RECEIPT NO I DAIS/ BY
OOSE SEWER CONNECTING TO
Nd
PRNVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR t EXCEPTION R CORD
WORK TO HOUSE SEWER lee I
ALTER OR REPAIR EXISTING I NO ATE 13Y
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CON ION DATA
SEPTIC TANKSEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2A0 I STATION DEPTH G
CESSPOOL—ORYWELL 1
SPECIAL CONDITIONS ONLY 200 1 / A / MANHOLE EREFERENCE LOWER
�E OF CO
NNE CTI P L LENGTH
L TORP FROM /
OWNERS PERMIT : 1 00"
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORSBIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS' _ DAY a 19s51
NEW HOUSE SEWER
I CONNECT ADDITIONAL
OWNER
DD R S l AGENT� - i� - ---( AND/OR DRA BEEP
F ELD IT(8)
ADDRESS D[ �(r(�`
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ' CESSPOOL[3DRYWELL E y
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE+
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSA16 SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISI`ERED4 DISCONNECT PLUS 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 DES7BED 1
rIDENTIAL PROPERTY BACKFILL SPTIC TANKS
OFERRLII! SEEP PIT(8)O CESSPOOLS s G yj C / e S t
SIGNATURE
70AWD 663 1/53 I /