HomeMy Public PortalAbout5715 NOEL DR_Sewer__ 76A648D APPLICATION FOR PERMIT ],
o s "SIVISION OF SUII.DING AND SAFETY SEWER-SEWAGE D i SPOSA L
Department of County Enginees
County of I.De Angelos BUILDING
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GR46—cp
SUP T OF BUILDING LOCALITY
FOR T L IN NEAREST
CROSS ST
LEGAL .
DESCRIPTION LO OWNER
BLOCK TRACT MAIL
ADDRE
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
7 BUtLD7NGSDISTRICT NO I GROUP I BK MAP PG
CONTRACTOR r e
ADDRESS ~ ' CONNECTION DATA
CITYTEL NO STATION DEPTH
❑ STATE Aa Ll.fZ ANBpiE RE NCE
REGISTRATION NO ®'beMNiY �` LOWER
TYPE ECTION lifiefil FROM
No DESCRIPTION OF WORK FEE Y C B P L M L TO P L /
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ((� : 350 fz
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO
WORK TO HOUSE SEWER 100 ��/
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
ITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE IN PECTOR S SIGNATURE
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY 19_
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPT C TANKS❑
SEEP PITS CESSPOOLS
SIGNATUREOQ
OF PERMITTEE
WILLIAM J FOX.CouNTY ENoiNEER VALIDATION
ti
By DE p 5 8 8A W 2 5 4 4 5 0 t0 DEPUTY
BY BY
® DEPUTY DEPUTY