HomeMy Public PortalAbout5631-5633-5635 NOEL DR_Sewer__ DEPARTDIFNT OF COUNTY ENGINEER ySEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEERBUILDING
CASSATT D GRIFFIN SUPT OF BUILDING ADDRESS /) 'j
BUILDING FOR APPLICANT TO FIL IN j� LOCALITY ___nA',A/1
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LOCALITY /ly
DISTRICT NO SERIAL NO / / PERMIT NO
NEAREST
A 0U(�' S
CROSS ST p _
'OWNER a9d�'� 4dj0 f/ 4 RECEIVED AY Re=dyf=�l1eotion DATEISSUED`��
ADDRESS/,1;2,f-MAIL
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CITY /9-,,, "WrIV A TEL NO 4c 324 1 1 0..�z I � P
CONTRACTOR /94fle Tl� �..b / C.#* CHC RGES REIMBURSEMENT FEE
ADDRESS .3 (� FD aT.CI 4.G REQUIRED
CITY kc �� TEL NO 3 /_7J' NOTREQUI ER D
JOB No Ll I CONNECTION C FEE
REGISTRATION NO C COUNTY L3 JV CO IMP NO L �o E
STATE
LEGAL RECEIPT NOC_ I DATE BY _
DESCRIPTION LOT NO
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BLOCK TRACT //. // ,4,/ � WAIVER�FOR;RECORDING
,L
SIZE OF LOT NO NOW ON LOTS 1 RECEIPT DATE _�,BY
su LDINGS 3 U1117- Dull///j(/.7-
NO DESCRIPTION OF WORK -- FEE_ TRUNK PERMIT NO
PUBUSE LIC EWESEWRCONNECTING TO ; 3 50 ROAD PERMIT NO "
HOUSE SEWER CONNECTING TO `" STATE ENCROACHMENT--
PRIVATE DISPOSALSYSTEM 100 PERMIT NO
CONNECT ADDITIONAL BLDG OR
INDUSTRIAL��
WORK TO HOUSE SEWER 1 00 WASTE-AP
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM, 1 00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM - 1 00 STATION / DEPTH
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 MANHOLE REFERE �+ e 4:0N I
CESSPOOL—DRYWELL UPPER I "'- LOWER. '
SPECIAL CONDITIONS ONLY 900 TYPE OF CONNECTION LENGTH FROM
Y CURBr P L M L'TO P L 6/
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'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19aS3 NEW HOUSE SEWER3-�--
OWNER OR A' CONNECT ADDITIONAL
OWNERS AG y� �`� BUILDING OR WORK
ADDRESS ger 0 tf+t�+-0r�'ra�`-�... SEPTIC TANK SEEP PIT(S) `
�1Z' AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIRSEWER
REGU�AT NO PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND _
AND STATE OF C F RNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVIL DESCRIBED RESIDENTIALPR� BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)E] CESSPOOLS
41 OF PERMITTEE _
i 6A642D 663 12/12-
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