HomeMy Public PortalAbout10248 NADINE ST_Relocation__ ' DEPARTBIENT OF COUNTY ENGINE LR SEWER—SEWAGE DISPOSAL9 8
DIVISION OF BUII•DING AND SAFEVW ,t PERMIT APPLICATION
• COUNTY OF LOS ANGELES
ti WILLIAM J FOX. COUNTY ENGINEER BUILDING / D
ADDRES8 T
• FOR APPLI NT TO IN LOCALITY
BUILDING • NEAREST
ADDRES8 WA0CROSS ST
LOCALITY • t DISTRICT NOSERIAL NO PERMIT NO c
NEAREST I A /9,0 3 $
-7
CROSS ST
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER—ZAAwd tLx/ /— `s _.
MAIL USE TONE I / ANCY BK MAP P8
ADDRESS //
t
CITY TEL.NO
i t
CONTRACTORC1llPornl$ Sewer Const•Ca. Co IMP NO �� 9
ADDRESS 1317 Colegrove Ave. i JOB No
CITY M ntebello TEL milMion 1-5048 , TRUNK PERMIT NO
REGISTRATION No 104445 STATE
S't�t®UNTY" ROAD PERMIT NO —�
LEGAL PERTMITNOROACNMENT
DESCRIPTION LOT NO
BLOCK TRACT 4JR41 INDUSTRIAL
SIZE OF LOT NOW ON LOTS t CHARGES
USE DINGS
BUILDICONNECTION CHARGE FEE\
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
PUBLIC SEWER�NNECTINB TO ® ' 359 RECEIPT NO D E I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM too
CONNECT ADDITIONAL BLDG OR EXCEPTION CO ED
WORK TO HOUSE SEWER foe
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISAND/ORNDISPOSA SYSTEM AND ABANDON SEWER in nNNE-CTION DATA
SEPTIC TANKSEEPAGE PIT OR 6
PITS AND/ORDRAINFIELD 240 STATION �'I'� Oi S DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 53 8 NUPPEREFERENCE
TYPE OF CONN TIO LENGTH FROM
OWNERS PERMIT : 1 00 -Y� Cb4Hb 6;7> ML TO P L 7
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH TME HER IN NAMEDI
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING{ APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUB C SEWER
SIGNED THIS OF 1 NEW HOUSE SEWER o V-0 G
OWNER 0 A CONNECT ADDITIONAL
OWNERS A _ _ BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL[:] DRYWELL E3
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 DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG 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 DES0 BED DENTIAL PROPERTY BACKFILL SEPTIC TANKS O
SIGNATURE
i SEEP PIT(8)0 CESSPOOLS c ye r _ S.
OF PERMITTEE I
TOA642A 663 7/53