HomeMy Public PortalAbout5517 NOEL DR_Sewer__ :alte same APPLICATION FOR PERMIT 1
DIVISION OF SUMDMG AND SAFETY SEWER- EWAGE DISPOSAL
DGpt1 Of LOS of Zgelm BUILDING !
) A 1 Q
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN BUIS T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
LEGAL
DESCRIPTION LOT NO 17 OWNER
BLOCK TRACT MAIL
ADDRESS
NO OF SLOGS J
SIZE OF LOT NOW ON LOT CITY TEL NO (p
USE OF
BUILDINGS Rt: DISTRICT NO GROUP MAP
BK
CONTRACTOR
ADDRESS CONNECTION DATA t
CITY TEL NO i STATION , ,�j ` DEPTH
SOVATE MANHOLE REFERENCE UPPER
REGISTRATI NO ❑ COUNTY
No I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO $ 9 BO O �+� TYPE O CNOM.NNECTIOP L LME`GTO P L FROM
PUBLIC SEWER62
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR P C NO
WORK TO HOUSE SEWER 100 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM too TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT HC
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPR VAL
SPECIAL CONDITIONS ONLY 200 CHARGES
O%%,=S PERMIT $ ' 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
P
HIS
CTED
ITH THE
TRACTOR TTo CONNECT THEDATE AABOVEWDESCR BED EXISTING DWELLIING IN KAMED CON APPROVALS DATE !NS ECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THI Y OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS-5AND/Olt DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
D CRIBED BESTIAL PR ERTY
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SEEP FPIT SBACKILL EP❑CCESSPOOCLS
OF PERMITTEE
WILLIAM J FOX COUNTY ENGINEER VALIDATION R A WOOD CHIEF PLBG INSPECTOR
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