HomeMy Public PortalAbout5575 NOEL DR_Sewer__ -�j DEPAK'I`M�NT' OF COUNTY ENGlNEEIi ' SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PERMIT APPLICATION
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
i ADDRE88
FOR APPLICANT TQ FILL I LOCALITY
BUILDINGNEAREST
ADORE CROSS ST
LOCALITY DISTRICT NO SE 0 P RMIT NO
NEAREST '� A S S
CROSS ST
E ED Y Ready for Inspection DATEISSUED
OWNER lb /i/ J
MAIL
D REBS �j�� USE ZONE CCUBKPANCY MAP G
ClT TEL NO /
CONTRACTO CO IMP NO
ADDRESS e .�► JOB NO zz-/6
Cl TEL NS TRUNK PERMIT NO
REGISTRATION NO ���rri3® ❑ COUNTY ROAD PERMIT NO
LEGAL �� STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT /G��G INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF BLDGS /
NOW ON LOT CHAR
USE OF
BUILDINGSJ� CONNECTION CHARGE FE
NO DESC ION OF WORK FEE
REIMBURSEMENT FEE
NOOSE SEWER CONNECTING TO
PUBLIC SEWER as 350 RECEIPT NO I ATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR E ION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING N I DATE BY
SEWER OR DISPOSAL SYSTEM too
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM too cbNNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 200 STATION �- �,�,� DEPTH
CESSP00 L—D RYW ELL
SPECIAL CONDITIONS ONLY 2 00 �L' Z ANI�P ER EFERENCE 91110mTYPE OFCONNECT✓A LENGTH FROM
OWNERS PERMIT ; 1 00 I:tW P L M L TO P L
AUTHORIZATION TOTAL FEE 41b
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_ _ DAY OF __ _ __ _ _ _19..._. NEW HOUSE SEWER , .��
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ _ _ _ _ _ _ _ BUILDING OR WORK
ADDRESS _ _ _ _ _ _ _ _ _ AND/OR DRAINFIELD IT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE IS 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS QUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFO A OR T T t AM THE LEGAL OWN-
ER OF THE ABOVE D IBED IDEM IAL PR_CPJERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)E] CESSPOOLS
OF PERMITTE
76A642A 663 7/53 `