HomeMy Public PortalAbout5625-5627-5629-5629 1/2 NOEL DR_Sewer__ DEPARTMENT OF COUNTY ENGngEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS "GEL=
BILDIN
i WILLIAM J. FOX, COUNTY ENOINEER ADDRESS 6 j /_7 g �76
FOR APPLICANT TO FILL IN LOCALITYBUILD' C c
ADDRESS% - 7 - CROSNEAS ST
LOCALITY ' DISTRICT NO SERIAL 90 PERMIT NO c
NEAREST A S
CROSS STad ECEIVED BY NOR&for In{ptnuen DATE ISSU D
OWNER �..,/
MAIL
` �� USE NE OCCUPANCY SK MAP PB
CITY TELMO. �"�� I L h- bS—,
CONTRACTOR CO.IMP MO
ADDRESS 44aM - AW _ SOB NO Lit yz 1-6
CITYtTELN� TRUNK PERMIT NO
REGISTRATION nor Rego p COUNTY
ROAD PERMIT NO
LEGAL �1�+ STATE ENCROACHMENT
DESCRIPTION LOT NO �! PERMIT NO
BLOCK TRACT INDUSTRIAL
``�� WASTE APPROVAL
SIZE OF LOT�Z X '�:r NOW ON LLO-08-Al"
S. t pfe�G CHARGES
USE
BUILDINGS N E CONNECTIOFEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER { 350 O RECEIPT NO TE BY
HOUSE SEWER CONNECTINO TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORD
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM too
ANDIOR DISPOSAL SYSTEM SEWER 100 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION A DEPTH
CESSPOOL-ORYWELL
SPECIAL CONDITIONS ONLY 200 4/1
/ ANHOLE REFERENCE ^LOWER
Y TYPE OFCURB ECTIO P L I/111 L TO P L OM
OWNERS PERMIT $ I 00
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR' SIGNATURE DA
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--DAY OF _ ly NEW HOUSE SEWER S
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT __ _ _ _ _ . __ _ _ ,_,_, BUILDING OR WORK
ADDRESS
SEPTIC TANK
DRAINFIELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[3 DRYWELL I]
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
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTYUSE AND
DISCONNECT ABANDON HOPLUG PLUG AND
AND STA/oRTE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS E]
SIGNATURE SEEP PIT(S)0 CESSPOOLS 0
OF PERMITTEE
TOA642A 663 7/53