HomeMy Public PortalAbout5700-5702-5704 NOEL DR_Sewer__ -�' PDEPARTMENT OF 00IINTY ENS SSR.-,SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNW OF LOS ANGELES
WILLIAM J FOX COUNTY ENSINEER BUILDING `�Oe%r ►
CASSATT D CIRIFrIN SUP Tor Illumo m 1 ADDRESS��Q�_
FOR APPLICANT TO FILL IN , LOCALITY / C; _
BUILDING I NEAREST
ADDRESS CROSS ST
LOCALITY J:dDISTRICT NO SERIAL 1(0 J PERMIT NO c
NEAREST V A o 7 `
Qt A.1 7 J
CROSS ST CEIVED BY Ready for Ia{poetloa DATE ISSUED
OWNER
AMAIL DDRESS USE ZONE,-" OCCUPANCY MAP
BK PG
CITY TEL NO
CONTRACTOR -�+- I/ CHARGES REIMBURSEMENT FEE
ADDRESS 4 J L 3 Ca' 1 32pld c.,'+, REQUIRED
NOT REQUIRED
CITYTEL q JOB NO CONNECTION CHARGE FEE
REGISTRATION N f q0t 20-19 ( WtAunr CO IMP NO
LEGAL / RECEIPT NOI DATE
DESCRIPTION LOT NO
BLOCK TRACT j�.� 161166 t WAIVER FOR R RDING
SIZE OF LOT NO OF GLOBS ' RECEIPT NO TE BY
NOW ON LOT
USE OF
BUILDINGS 1�- TRUNK PERMIT N
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ryl ROAD PERM O
PUBLIC SEWER 0 $ 800 i� "' STATE ROACHMENT
HOUSE SEWER CONNECTING TO ST RT 0
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR IN TRIAL
WORK TO HOUSE SEWER 100 TE APPROVAL
SEWER OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
DOSABANDON SEWER
ANR
DISCONNECT AND
SE 100
SEPTIC TANK SEEPAGE PIT OR STATION B $ DEPTH 6
PITS AND/OR DRAINFIELD 200 I MANHOLE REFERENCE
CESSPOOttDRYWELL UPPER �..��� DOW
9 si e9
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION P L LENGTH
E TOfP EOM 3 a
OWNERS PERMIT $ I 1 00
AUTHORIZATION TOTAL FEE JV
CONTRACTOR TO CONATE NECT THE ABOVE DESCRIBED�EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS�I� Y F7�j__.PVt - - Iq NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS A8 NT s i_ _ - - BUILDING OR WORK
ADDRESS _ SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL[] DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AGREE
TO COMPLY WITHALL NTY 0 INANCES AND LAWS ALTER REPAIRSEWER
HE PLUM I 8 ND SEW R8 SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTI THAT 1 PROPERLY GISTERED DISCONNECT PLUG AND
AND/OR LICENSED A REQUIRED BY LOS ANGELE COUNTY ABANDON HOUSE SEWER
AND STATE OF CALI RNIA OR T AT 1 AM THE LEG L OWN
ER OF THE ABOVE RI D R ENTI PROP E BACKFILLSEPTIC TANKS
�
SIGNATURE SEEP PIT(S)0 CESSPOOLS
OF PERMITTEE
76AS48D 663 18/52