HomeMy Public PortalAbout10229 NADINE ST_Sewer__ DEPAl9ra0rrr OF OOUNTY IINGDnC= i SEVIIER E111/A61~0lSPOSAL 9431
~%, DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
• COUNl'Y OF LOB "GELEB
hR V� WILLIAM J FOX COUNTY ENGINEER ABDD EISS /Q
FOR APPUC NT TOa LL IN LOCALITY
BUILDING
ADDRESS NEAREST
t CROSS Sr
d LOCALI DISTRICT NO SERIAL GO PERMIT NO
OROSR ST { . A ! Q S
C
OWNER ED Ready for Insomilm DATE ISSUED
MAIL 3 rJ
ADDRESS USE ZONE OCCUPANCY MAP
_ BK PO
f CITY y TEL NO A— I
r CONVIRAVTOR B81i�e nn,a ,SP`me^nn Co IMP NO L¢.9
ADDRESS ' 1817 (181A rev
g e Ave- jos No
CITY mantabAl In TEL NO TRUNK PERMIT NO
REGIST ATION NO S TY ROAD PERMIT NO
LEGAEvf
DESCRIPTION LOT NO STATE
ENCROACHMENT
CROACHMENT
BLOCK TRA ����• INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT +� a,O NOW ON LOTS CHARGES
USE OF
BUILDINGS CONNECTION CHARGE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTINO TO REIMBURSEMENT FEE
PUBLIC SEWER ! f 850 39M RECEIPT NO D T I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION ECO ED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING No DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATION 3-� Z d DEPTH
CESSPOOL•–DRYWELL
SPECIAL CONDITIONS ONLY 2001 r-� 1 MANHOLE 1 LOWER
TYPE OF CONNECTIOP L LENGTH FRO
OWNERS PERMIT i I OD
CURB_ M L TOP L 4
AUTHORIZATION TOTAL FEE
1 HAVE TH18 DATE CONTRACTED WITH THE-HEREIN NAMED ~
CONTRACTOR TO CONNED THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE P SEWER -�
SIGNED THIS _DA OF _ .6 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRE88 .�e�vL s AND/OR DRAINFIELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL[] DRYWELL[7
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR.SEWER OIL
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECTpLUG AND
AND/OR LICENSED AS REOIULED BY 4LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE ABOVE DESC fIED ESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS o
SIGNATURE /' ) SEEP PIT(S)C] CESSPOOLS
OPPERMITTEE ltld� ! ____ •
A 7"11421) 008 1/88 4 +!