HomeMy Public PortalAbout5720 NOEL DR_Sewer__ :g$°s 8,185 APPLICATION FOR PERMIT 1
DIVISION OF BUHMING AND SAFETY SEWER SEWAGE DISPOSAL
D"c t wW of CouaiY Englnaer i �f _
COuaty of Los Aagele6 ADDRESS G ✓ / B
JOHN A LAMBIE COUNTY ENGINEER
® CASSATT D GRIFFIN SUP T of BUILDING LOCALITY
FOR APPLICANT TO FML IN CROSS ST 4X� X
LEGAL
DESCRIPTION LOT NO ®plk A[ Z / OWNER � e
MAIL
BLOCK TRACT y _ ADDRESS - T,
NO SIZE OF LOT % `V 17 NOW OONBLOT S vim► CITY T� Cq TEL NO
BUILDINGS C I(/�i �F /I IV DISTRICT NO I GROUP OF BK NAP PG
CONTRACTOR `/A 1 A/
ADDRESS �` CONNECTION DATA
/ STATION DEPTH
CITY Q� TEL NO e J MANHOLE REFERENCE UPPER
STATE LOWER
REGISTRATION NO o V ✓ [3-409NTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $S 50 Y CURB P L M L TOPI.
SEPTIC TANKSEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $S 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO INP NO JOB NO
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 0 $1 00 40 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PST s 1 00
AUTHORIZATION TOTAL FES REIMBURSEMENT FEE
I HAVE AT THIS DATE CONTRACT WIT rHE H EIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONN TH VE IBED
STING DWELLI
TO THE To NEW HOUSE SEWER
SIGNED THI AY 1 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK {
OWNERS AGENT if SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
4HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PRO L REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY OS AN ES LINTY AND STATE OF
CALIFORNIA 0 T i E A 11(N THE ABOVE ABANDON HOUSE SEWER
DESCRIBED AL BACKFILL SEPTIC TANKS❑
SIGNATUR e SEEP PIT(S)❑ CESSPOOLS❑
OF PERM
JOHN AThr ALIDATION ROBERT A WOOD CNIEF PLBG INSPECTOR
j / C r O CAsIf
4 4 ; SIR 8 1 A 200 A
i
DEPASTAIENT OF COUNTY INGngMMM SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LO$ ANGZL= BUILDING
WILLIAM J FOX. COUNTY ENGINEER 'I ADDRESS 3'12.<S V-jP1 Qa)[ kyN
FOR APPLICANT TO FILL IN LOCALITY= I
ADDR NO
S Z /n /S/O AA R &e P- CROSS ST -'
LOCALITY / M Ei - d . r y (!AI- L Igo DISTRICT NO SERIAL NO PERMIT NO
A S
NEAREST ee
CROSS ST
RECEIVED BY Ready for laepeetloo DATE ISSUED
OWNER
MAIL S , USE ZONE OCCUPANCY BK MAPDDRPQ
CITYl.0C,124-mo r' 13
CONTRACTOR rh NanCO IMP NO 3 - Z Q
ADDRESS 5M N. CUMEM Y AN& JOB NO
CITY TBMKRNVrye CALIF TRUNK PERMIT NO
REGISTRATION NO COUNTY
ROAD PERMIT NO
LEGAL I
DESCRIPTION LOT NOSTATE ENCROACHMENT .�..�.
a. 3 Z PERMIT NO
BLOCK TRACT S�� WASTE APPROVAL
SIZE OF LOT �� Jf��Q NOW ON LOTS CHARGES
USE
BUILDINGS CONNECTION C GE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOSE SEWER CONNECTING TO
PUBULIC SEWER 41 1 330 O RECEIPT NO D BY
HOUSE SEWER CONNECTINO 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
NDION DISPOSALS STEM SEWER 100 CONNECTION DATA
PITS AND%OR DRAINFIELDT OR 2AD STATION '�Z-j DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 200 S (�M REFERENCE
A�TYPE TLENGTH L FROM
MOP _2S
OWNERS PERMIT 1 pp /
AUTHORIZATION TOTAL FEE ' '%
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS ._ DA OF —1 NEW HOUSE SEWER I A4-qL
OWNER OR CONNECT ADDITIONAL
rt BUILDING OR-WORK
OWNERS AGENL
IT(8)
ADDRESS-"-' �Q . i4 AND/OR DRAIFED
CATION AND STATE THAT THE ABOVE 16 CORRECT TTAND AGREE CESSPOOL DRYWELL
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED A8 REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT t AM THE LEGAL OWN
ER OF THE A��yy" SEEP PIT(S)[] CESSPOOLS S—BOVE BE RE8ID TIAL PROPERTY BACKFILL EPTICTANKS�
SIGNATURE ;
i
OF PERMITTEE
70A842A 663 7/58 '
r ,