HomeMy Public PortalAbout5643-5645-5647 NOEL DR_Sewer__ DOF COUNTY EATGINEEB SEWER—SEWAGE DISPOSAL
j DIVISION OF BIIILDING AND SAFETY + PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS SZ* 7 No t/ 4D f-
FOR APPLICANT TO PF LL IN LOC�`L'- 716kn 7 le6 74
ADDRESS /� NEAREST
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LOCALITY DISTRICT NO SERIAL NO PERMIT NO
CRORR ST/( /0 Q F A /1y Z &�L j 5
RECEIVED BY Wady for inspesUen DATE ISSUED
OWNER all fl-20-5-3
MAIL USE ZONE OCCUPANCY MAP
ADDRESS �w�� BK PQ
CITY TEL NO
CONTRACTOR CO IMP NO
ADDRESS JOB.NO Z J
CITY TEL NO TRUNK PERMIT NO —'
_REGISTRATION NO ✓4O.�ZZ S COUNTE TY ROAD PERMIT NO
LEGAL ^
DESCRIPTION LOT NO STATE ENCROACHMENT
Y PERMIT NO
BLOCK TRACT O O MOW ON LO / STP
SIZE OF LOT // NO OF SLOBS INDUSTRIAL
APROVAL
CHARGES
USE
BUILDINGS 1 CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE `--
MOUSE SEWER CONNECTING TO
PUBLIC SEWER -@ 11 330 3 6-0 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER. 100
ALTER OR REPATB EXISTING NO I DATE BY
SEWER OR DISPOSAL SYSTEM 100
AND OR DISPOSA SAND YSTEM SEWER I M CONNECTION DATA
SEPTIC
ITS AND%OR SEEPAGE PIT OR STATIONDEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 MANHEOLEREFERE C ,// O'T/•LOWER
I .UR6R- r
TYPE OF CONNECTION
ECTIO L TP FROM
Y URBP L �MO D
OWNERS PERMIT $ I 1 00
AUTHORIZATION TOTAL FEE ( 6-D I
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED,
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOWS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THISDAY OF NEW HOUSE SEWER 3
_...... __ 19� -L 2
OWNER ORCONNECT ADDITIONAL
�
OWNERS AGENT — _ __ _ ��_ R_ BUILDING OR WORK
SEPTIC TANK,SEEP PIT(S)
ADDRESS ARD/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL❑
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS' ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS I SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THATRI AM PROPERLY REGISTERED' DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DE CHIDED RESIDE IAL PROPEBACKFILL SEPTIC TANKS 13
SEEP PIT(S)[3 CESSPOOLS 13
SIGNATURE
OF PERMITTEE
7"042D 663 1/53