HomeMy Public PortalAbout5701-5703-5705 NOEL DR_Sewer__ n�eAaT rr OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
t COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO LOCALITY '
BUILDING ` NEAREST
ADDRESS w.� / � CROSSST
LOCALITY Z/ G DISTRICT NO SERIAL NO PERM/ITJ NO
NEAREST A L �D�y3 S
CROSS ST
G RECEI ED Ready for Inspostlon DATE ISSUED
OWNER
MAILS ' USE ZONE OCCUPANCY BK MAPADO ES P8
CITY TEL NO t
rr�
CONTRACTI) I CO IMP NO
ADDRESS
JOB NO
CITY TEL NO P TRUNK PERMIT NO
REGISTRATIle ON NO �/B�Q COUNTYI
ROAD PERMIT NO
LEGAL t
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT ��� INDUSTRIAL
kt WASTE APPROVAL
SIZE OF LOT NOW ON LOTS i
,�rr CHARGES
USE
�j�ypj���J_/����ie' Ll CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE Or
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIO SEWER 0 s 350 3 sv RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO F
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING t DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT
ND OR DISPosNnDL SYSTEM DON SEWER loo 3 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.10 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 I MANHOLE
OER REFERENCEUPPi0GitF6R
TYP CONNE TIO P L LENGTH
L TO P L
OWNERS PERMIT $ I 1 00 mouffir-w
AUTHORIZATION TOTAL FEE
t HAVE THIS DATE CONTRACTED WITH THE HEREIN NAYEDt
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIM94 APPROVALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO TH PUBLIC SEWER 1
SIGNED THISO AY OF _ _ _) NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ _ BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS _ �1 ,. __ AND/OR DRAINFIELD
I HEREBY A NOWLEDGE THAT I HAVE READ THIS APPLI t CESSPOOL 0 DRYWELL
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
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY` ABANDON HOUSE SEWER
AND STATE OF CALI�RIBED
IA OR THAT AM THE LEGAL OWN
ER OF THE ABOVE R NTIA ROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(8)0 CESSPOOLS
OF PERMITTEE _ _
7"OUID 410 1/53