HomeMy Public PortalAbout5636-5638-5638 1/2-5640 NOEL DR_Sewer__ a�000- a�4v I.
24650 MOMC
78A84YD60 COUNTY OF APPLICATION
SAN ANGELES O N FOR E E"EWAGE DISPOSAL 1
DEPAlIn=T OF COUNTY ENGIIM
'
BURDING AND SAFETY DMSION ADDRESS ti
�OFII�(A LAMBffi Cenaly or ,
Sup 1 .,-L4 LOCALITY
NEAREST '
FOR APPLICANT TO FILL IN CROSS ST
LEGAL "
DESCRIPTION LOT NO OWNER „ -
BLOCK TRACT / MAIL
ADDRESS
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDING DISTRICT NO GROUP K YAP P ESSED BY
pe
CONTRACTOR
ADDRESS v CONNECTION DATA
CITY TEL NO STATION DEPTH
STA MANHOLE REFER - UPPER
REGISTRATI NO COUNTY LOWER
NO I DESCRIPTION OF WORK FEE `
PUBLIC SEWECONNECTING TO $3 00
SEPTIC TgNK SEEPAGE PIT OR TYPE NNECTION LENGTH FRO"
PITS AND/OR DRAINFIELD G SS 00 Y CUBB P L MI. TOPI.
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL@ $200
HOUSE SEWER CONNECTING TO P C
PRIVATE DISPOSAL SYSTEM $1 0 CO IMP NO NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO RO ERYIT NO O
WORK TO HOUSE SEWER 3100 (7
ALTER R HOUSE i 00STATE ENCROA NT Ip
SEERPERMIT NO
INDUSTR
WASTE APP OVAL
CHARGES
OWNERS PERBUT 5 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK -
ADDRESS_ SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Ej DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES OUNTY AND STATE OF ABANDON HOUSE SEWER -
CALIFORNIA OR TH T M THE LE WNER OF THE ABOVE
DESCRIBED RESIDEN I OPER BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP PITS CESSPOOLSEl
OF PERMITTE a��
®� ALWATION ROBERT A WOOD
CL M 0 CARR SUPERVISING MECHANICAL.BNGINF=
_3.40
DEOF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRE s
FOR APPLICANT TO FI LOCALITY ,
BUILDING f CR08SST
ADDRESS
LOCALITY5� I DISTRICT NO SERIAL NO T NO
NEAREST A
CROSS ST EIVED BY Ready for Inspection DATE ISSUED •
OWNER —.21
MAIL USE E OCCUPANCY BK MAP PG
ADDRESS
CITY TEL NO
,
CONTRACTOR
ADDRESS JOB NO �� i
CITY714,
TEL NO — {TRUNK PERMIT NO �^
REGISTRATION NO 8 COUNTY
ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT ���/ INDUSTRIAL
/ WASTE APPROVAL
SIZE OF LOT Lol Z(') NO ON LOTS CHARGES
USE OF
BUILDINGS CONNECTI ARGE FEE
NO DESCRIPTION OF WORK EE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FE
PUBLIC SEWER ! i Sao O RECEIPT NO ATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECOR
WORK TO HOUSE SEWER 1 00 NO I DATE
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100 I
DISCONNECT
ND%OR DISPOSAL SYSTEM SEWER I GO CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATION 2, DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 �� MA ER FERENCE
TYPE OF CONNECTI LENGTH FROM ® /
OWNERS PERMIT ; I pp `11111L TOP L
AUTHORIZATION TOTAL FEE 1 44
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS D OF.-_ 19.__ MEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ ____ BUILDING OR WORK
_ _ _ ���_ _ _ _ _ _ _ SEPTICTANK. FIE PITS)
ADDRESS
AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL 0
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 IAM
PROPERLY REGISTERED DISCONNECT PLUG AND
NO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
ASTATE OF CALIFORNIA OR TH AM TN LEGAL OWN-
ER OF THE ABOVE DEED R NTI BACKFILLSEPTIOTANKS
SIGNATURE SEEP PIT(S)0 CESSPOO90
OF PERMITTEE_ _ _ _ _ _ _ _ ._ _ _ _ _ _ _
70A048A 003 7/53