HomeMy Public PortalAbout5637-5639-5641 NOEL DR_Sewer__ D 3'ARTJM[IMTT OF COUNTY ENGINEER. -lr,SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUMDING AND SAFETY PERMIT APPLICATION
COUNTY OF I" ANGELES
WILLIAM J FOX, COUNTY ENGINEER ADDRESS
BUILDING _
CASSATT D GRIFFIN BUP•T OR BUILDING
FOR APPLICANT TO FILL Itt LOCALITY
ADDRESS .7 1-41- O C� D NEAREST
47
CE
LOCALITY �� p*C C DISTRICT NO SE L NO PE 0
CNEAREST ROSS ST �/F A � S
ftno We� LSI � � I / _ aeAIVED Ready for Inepeotlon DATE I88
UED
OWNER —"ir...6 W 2
DDMAIS��AJ L f!-'aJ I& 13 y,
ADDRE88 �� USE ZONE OCCUPANCY
MAP
P a
CITY TEL NO
CONTRACTOR �/9-�PL.''"�� A-Q Jrb I L, CHARGES IMBURSEMENT FEE '1
i
ADDRESS ,3 �- �r�r L, ` REQUIRED '
CITY S TEL N0/�/,S I J- OB NO UIR D� `w DONNE HARGE FEE '
REGISTRATION NO �/ b µ�i CSOUNTY CO IMP NO
LEGALRECEIPT Ne DATE BY
DESCRIPTION LOT NO
BLOCK TRACT / ) WAIVE ORDING
SIZE OF LOT NO OF BLDGS RECEIPT DATE-----[Ry
NOW ON LOOTT
USE
BUILDINGS ti3 Vt*#'r )WC11# s `
NO DESCRIPTION-®F=WORK-� F E TRUNK PERMIT NO
HOUSE SEWER CONNECTING TO ROAD PERMIT NO
PUBLICSEWER as 860
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 100 PERMIT NO `
CONNECT ADDITIONAL BLDG OR I INDUSTRIA
WORK TO HOUSE SEWER 100 W ,8 ROYAL
ALTER OR REPAIR EXISTI IG
SEWER OR DISPOSAL SYSTEM 100 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 STATION l ^ DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 200 MANHOLEREFERENC I -
CESSPOOL-DRYWELL UPPER I I
SPECIAL CONDITIONS ONLY 200 TYPE OF CONN� ON P L M L TOP ROM
�.
y
OWNERS PERMIT $ I 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOIW4pESCt;IBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THEUBC SEWER 'tet
SIGNED THIS 7/DAY O �''f fi 19 NEW HOUSE SEWER �S►
OWNER OR CONNECT ADDITIONAL
OWNERS A T e��}_, / .l, BUILDING OR WORK
ADDRESS _-1 1 Y —- r _ pND%OR DRAINFIELD IT(8) - e
4
I HEREBY ACKNOWL DGE THAT 1 HAVE-READ THIS APPL- ESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIRSEWER
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CE IFI THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
ANO/OR LIC S REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STAT OF CAL ORNIA OR THAT i AM THE LEGAL OWN-
ER OFS
TN ABOVE ESCRISED REST NTIAL PRO BACKFILL SEPTIC TANKS nn
SIGNATURE SEEP PIT(8)r CESSPOOLW� r
OF PERMITT '1=
TOA642D 663 18/68 F