HomeMy Public PortalAbout5719-5721-5723-5723 1/2 NOEL DR_Sewer__ DI PARTAKENT OF COUNTY ENGINZ>eCli I SEWER-SEWAGE DISPOSAL 1
DMSION OF BUMDING AND SAFETY ! PERMIT APPLICATION
COUNTY OF IAS "Cum=
WILLIAM J FOX, COUNTY ENGINEER BUILDING / ���
AGGRESS
rF�Oj R gAPPLICANT TO RLL
wIN` LOCALITY
ADDRESS
V/�/"L���3�Z3 CR0888T / 1
LOCALITY DIS R NO Ready for Inspection PERMIT NO c
NEAREST `�0 3 S
CROSS ST
E E DAT ISSUED BY DATE
OWNER _ 13 � 9P
MAIL USE
DDRESS ZONE I OCCUPANCY __ MAP PG
AKOK 6
CITY TEL.NO �
CONTRACTOR I�1/f�� CO IMP NO
ADDRESS SIS CL=/ja JTD S JOB.NO .. T
CITY vAos, TEL NO 3V TRUNK PERMIT NO
REGISTRATION NO /y G V477 MC COUNTY
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
/ y PERMIT NO
BLOCK TRACT �� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTeOX ISV NOWOOF N LBLOTDGS. J CHARGES
NO
USE OF ��/TS A rr rr,4dit CONNECTION C GE FEE
BUILDINGS •
NO DESCRIPTION OF WORK FEE
/ HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER 0 $ 880 47 RECEIPT NO DA BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING DATE BY
_ SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
- SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATION t DEPTH
—CESSPOOL—ORYWELL ' / NHOL�E RREFERENCE LOWER
SPECIALCONDITION80NLY 200 ���
Y TYPE OF CONNECTION
ECTIO P L. r M L T FROM
L OM�Q
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE S??
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPE OR8S16NATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF I9__ NEW HOUSE SEWER 1 M
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ „_ _ _ BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS _ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL❑ 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
SI OF THE ABOVE
—Irl
DESCRIBED RESIDENTIALPROPERTY BACKFILL SEPTIC TANKS
SSPOO Q
SIGNATURE BEEP PIT(S)� CESSPOOLS o
OF PERMITTEE —
7"642D Sacs 888 4/84