HomeMy Public PortalAbout10236 NADINE ST_Sewer__ DEPAIirmOCNT OF COUNTY ENGINEERi
SEWER-SEWAGE DISPOSAL 9421
J`DIVISION Ole 33MLDING AND SAFETY PERMIT A�PLDATION
COUNTY OF LOS ANGELES /� Z
WILLIAM J FOX COUNTY ENGINEERgDDRESS ILDIN
FOR APPL ANT T FILL IN - LOCALITY -P C-(�.
ADDRESS D� CROSS ST -•C R
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST t�r A Q 3 S
CROSS STS
RECEIVED Ready for IosOootloa DATE ISSUED
OWNER A A
MAIL
ADDRES8 USE ZONE OCCUPANCY I BK MAP PO
CITY ( TEL NO _ J
CONfRACTORIUvanrOP21i9. .sumer lcous��_ CO IMP NO
ADDRESS 1317 Colegrnme Awq. JOB No ---
CITY ito ntebell0 TEL N%2 - 4� TRUNK PERMIT NO
STATE
REGISTRATION NO 10444 8 COUNTY ROAD PERMIT NO
LEGAL C,%? �� 2// S 7 b STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT l S6 Lp p� INDUWASE APPROVAL
SIZE OF LOT ^ NO OF BLDG8
NOW ON LOT `CHARGES
USE OF f
BUILDINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER G $ 850 RECEIPT NO I DAT!�: BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION CORD D
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO ATE BY
SEWER OR DISPOSAL SYSTEM 100
DISAND/OR DISPOSAL SAND YSTEM SEWER loo
COtitfECTION DATA
PITS
SEPTIC TANK
DRAINFGELDPIT OR 2 b
CESSPOOL—DRYWELL STATION �t O O DEPTH
SPECIAL CONDITIONS ONLY 200 J$ 3 1 dl NUPPEREFERENCE L
V_
TYPE 0_F CONN
Ttayp LM L TO�FLOM 2
OWNERS PERMIT ; I 00 fP L,7 L_
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO THE^�PUBLIC SEWER �pp
SIGNED THIS Hilt_ DAY OF _ 190 NEW HOUSE SEWER � _ 3
OWNER OR CONNECT ADDITIONAL -
OWNERS ABENT //�� BUILDING OR WORK
SEPTIC TANK SEEP.PIT(8)
ADDRESS ICV - - - AND/OR DRAINFIELD
CATION AND STATE THAT THE ABOVHAVE
IS CORRECT ANO AGREE CESSPOOL DRYWELL
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE I AW8 ALTER REPAIR SEWEROR -
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUS AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT i AM THE LEGAL OWN
ER OF THE ABOVE DJSIBEOW RESIDENTIAL PROPERTY
BT LLS PTIC TANK
SEEP PIT(S)o CESSPOOL loo
SIGNATURE StBNATURE -
OF PERMITTEE �j
7""m 005 1/68 //