HomeMy Public PortalAbout5628 1/2 NOEL DR_Sewer__ DOF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BMLDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRE88 6 z '�
FOR A PLICANT TO FILL IN LOCALITY
BUILDING / �� CROSS ST .40
ADORE
LOCALITY A• O i DISTRICT NO SERIAL NO �PERMIT NO
re S
NEAREST '
CROSS ST r0 B Ready for lospeetlon DATEJS8UEDQ
OWNERcAva- e�j� /�A�C
ADDRESS ���Z% �2� /f//l SS/6 7•' �iSE ZONE , OCCUPANCY BK
MAP PG
CITY ' R p f TEL NO �_ S
CONTRALTO CO IMP NO Q
ADORES JOB NO 4L•2 r -U
CI EL NO TRUNK PERMIT NO 1"
TATE
REGISTRATION N COUNTY ROAD PERMIT NO
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTN0OW OFON LBLDGSOT CHARGES
BUILDINGS 4 r�l� CONNECT CHARGE FEE
NO DESCRIPTION O WORK REE
HOUSE SEWER CONNECTING TO REIMBURSEMENT F
PUBLIC SEWER ! l) 550 RECEIPT NO BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
AND/OR DISPOSAL SYSTEM SEWER I S 1 CONNECTION DATA ..y�
SEPTIC TANK.SEEPASE PIT OR STATION / 9 O /.
PITS AND/OR DRAINFIELD 200 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 �� /�/MANN REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM /
OWNERS PERMIT ; 00 Y CURB P L )I/M L TO P L
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREI 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
CONNECT ADDITIONAL
OWNERS OR
_ „ . _ _I BUILDING OR WORK
ADDRESS _ _ _ _ _ _ _ _ ._
SEPTIC TANK,
DRAINFIELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL I]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS1 ALTER.REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED( DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALI RNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOV RIBED IDENTIAL PROPERTY BACKFILLSEPTIOTANKS❑
SIGNATURE /�� SEEP PITS)I] CESSPOOLS 1]
OF PERMITTE - w _ _ ..- _.- _ _ _ _
70A042A 005 7/58