HomeMy Public PortalAbout5630-5632-5634 NOEL DR_Sewer__ DEPASTMENT OF COUNTY ENdIINEM SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOTS ANGELES
ILDING
s WILLIAM J FOX, COUNTY ENGINEER ADDRESS �y�O �y `
CAMMATT D ORIrrIN BYPT OF BUILDING _
FOR APPLIC NT TO FILL IN LOCALITYBILDING NEAREST
ADDRESS CROSS 8T /r D AeappWA
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST �' A g3 99 7ya 9 5
CROS ST RECEIVED BY Ready for lospeottoo DATFASSUED
OWNER /Y//4" r Ar 840
AMAIL DDRESS USE ZONE OCCUPANCYS MAP
BK PO
CITY 2 TEL NO � Za
��v I
CONTRACTOR ^ `,.-yr u ` CHARGES REIMBURSEMENT FEE
ADDRESS Y+1 J�.l Z/�7 F�
CITY �'y,_. .� TEL -!s,4T 7L JOB NO :Lf&4/O CONNECTION CHARGE FEE
REGISTRATION NO �4
STATE
LEGAL " RECEIPT RECEIPT NO I DATE I BY
DESCRIPTION LOT NO /
BLOCK TRACT / G l/ G WAIVER FOR RECORDING
SIZE OF LOT6,4 41%,C pOW ON LOTS 2 RECEIPT NO DATE BY
� USE OF
I L I
BUILDINGS
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOa ROAD PERMIT NO
PUBLIC SEWER @ $ 3 80 U
HO8E SEWER CONNECTING TO 40A
PRFVATE DISPOSAL SYSTEM 100 PERMIT NO
/Mt CONNECT ADDITIONAL BLDG OR 0 IAIDUST.R
1 WORK TO HOUSE SEWER 100 WASTE APPRO
SEWER OR DISPOSAL SYSTEM too CONNECTION DATA
DISCONNECT AND ABANDON SEWER STATION 7�S& DEPTH
AND/OR DISPOSAL SYSTEM 100
SEPTIC TNDANK.8EEPAGE PIT OR
PITS A /OR DRAINFIELD 2 00I PE LE F NCE ,.
CESSPOOL—ORYWELL
SPECIAL CONDITIONS ONLY 200 T PE OF CONNECTION LENGTH FROM
Y CURB PL ML.TOPL
OWNERS PERMIT $ I 1 00 —
AUTHORIZATION I TOTAL FEE d?
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOWS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS D Y OF _ _ 19 — NEW HOUSE SEWER
OWNER OR BUILDINO 08 WORKAL `
OWNERS AGENT - � " - gEPTICTANK SEEP PIT(8)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKN WLEDGE THAT 1 HAVE RTHIS APPLI- CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS COR AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES 111, 80TSTATE LAWS ALTER REPAIRSEWER
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED. DISCONNECT PLUG AND
ND/OR LICENSED AS RE IRED BY LOS ANGELES COUNTY ABANDON NOOSE HEWER
ASTATE OF CALIF OR TH T AM THE LEGA OWN-
ER OF THE ABOVE D BE R NTIA PROPERI BACKFILL SEPTIC TANKS
SEEP PIT(S)[] CESSPOOLS
SIGNATURE
OF PERMITTEE _
78A842D 663 12/52