HomeMy Public PortalAbout10252 NADINE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-,SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGEL=
BUILDI
WILLIAM J FOX, COUNTY ENGINEER j ADDRESS
FOR APPLICANT
� TOS FILL IN LOCALITY C
ADDRESS 1,0282 J= 2;Uy /wE CROSS ST
LOCALITY T/J �y DISTRICT NO SERIAL NO h PERMIT NO
NEAREST A l�q g� — S
CROSSST ECEIVED BY Ready for Inspection DATE ISSUED
OWNER
AGGRESS B 1 'L t�.t�6i USE ZO I OCCUPANCY MAP
BK PO
CITY TEL HOMOM
CONTRACTOR (r��(/+� CO IMP NO
ADDRESS JOB NO
CITY TEL NO TRUNK PERMIT NO
STAREGISTRATION NO B COUNTY
ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO �1� PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT / NO OF ILDGS
S�r X 1C NOW ON LOT CHARGES
BUILDINGS 1 CONNECTION C FEE
NO DESCRIPTION Or WORKI FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 41 S 350 RECEIPT NO I D BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR XCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 100
ANDIOR DISPOSAL SYSTElN SEWER 1 00 CONNECTION DATA
SEPTIC TANKSEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOLr-DRYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
LOWER
TYPE OF CONNECTIOM�.� LME`TTOHP FROM 2`/
OWNERS PERMIT = I 00 L7
AUTHORIZATION I TOTAL FEE
ItV-
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED '
CONTRACTOR
NG ,O CONNECT
PLANE PUBLIC THE
ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLER
516NED THIS�.lOF t I� NEW HOUSE SEWER
OWNER OR rf '�„� BUIILDINB ORDWORKAL
OWNERS AGENT w
ADDRESS IO2d:1-- L_.L SEPTIC
IFID
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIS CESSPOOL[ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE El
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 CALIFO IAO T 1 AM THE LEGAL OWN
ER OF THE ASOV¢IDE IB RE ENTIAL PROPERTY BACKFILL SEPTIC TANKS(] \
SIGNATURE [0�I3/O'7 SEEP PIT(S)� CESSPOOLS
OF PERMITTEE _ _ _ _
76AG42A 663 7/59 n. lei