HomeMy Public PortalAbout5321 NOEL DR_Sewer__ Ctso$a ss APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
=MTN= OF COUNTY ENGERM ✓y
BUMMG AND SAFETY DIVISION ADDRESS y e-J
C NSATT D G8>FM Sup t of BuddingUILDING
TOM A.LR30M Countr LOCALITY
NEAREST
FOR APPLICANT TO F1LL IN CROSS ST to
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT ' Q MAIL
ADDRESS
NO OF SIZE OF LOT 0 NOW ON LOTS CITY 0
6
USE OF
BUILDINGS �� DISTRICT GR M PROCESSED BY
K 63 CONTRACTOR
d.,z�.o
ADDRESS t JF jr S7 CONNECTION DATA
CITY TEL NO A. Q&,OV 41,0'f— STATION 't"a O 7 DEPTH
REGISTRATION NO COUNTY
MANHOLE REFERENCE PPE
No I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER a $S Oo dQ
SEPTIC TATYPE OF NK SEEPAGE PIT OR TION LENGTH FROM
PITS AND/OR DRAINFIELD a :S 00 Y UR P L M L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRAILE MANHOLE .00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 41 $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMITNO ROAD PERMIT NO
WORK TO HOUSE SEWER 1 00 S
8EWER OR DISPOSAL ABANDON
HOUSE st 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OMER S PERM : 1 2100 CONNECTION CHARGE FEE
AIITHORIZATION TOTAL FES REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE To ER _
NEW HOUSE SEWER
SIGNED THI Y OF CONNECT ADDITIONAL
OWNER OR
OWNERS AGENT BUILDING OR WORK
SEPTICTANK SEEP PIT(S)
ADDRE '�� AND/OR DRAINFIELD
1 HEREBY ACKNOWL GE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL(] DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLT REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RES FM PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE
OF PERRI
Or VAII! ATI' CASM 5? ROBERT A WOOD
aE M o SUPERVISING MECHANICAL.ENGINEER
3533M 'XT 61 0 A 500 F