HomeMy Public PortalAbout5730-5730 1/2 NOEL DR_Sewer__ DEPA=JYIENT OF COUPM ENGNEE1i SE�Wt/ER-SEWAGE DISPOSAL 1
DIVISION OF BUUMING AND SAFETY PERMIT APPLICATION
r COIINTY OF LOB Al GELEB
WILLIAM J FOX COUNTY ENWINEER BUILDING
ADDRESS
FOR APPLICANT TCS, FILL IN LOCALITY
BUILDING ,r-730 .e ® A�� CROSS ST
ADDRESS J [��
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST ,7 A )3,28 G T6 S
CROSS ST I&AIL ole
i RECEIVED Ready for lospsodos DATE ISSUED
OWNER A J, /— c3
MAIL �✓��o �_a a' �� USE'2vONE OCCUPANCY C�BK MAP PJG
ADDRESS r7 (jam(
CITY TEL NO
CONTRACTOR CO IMP NO
ADDRESS —A—Ag JOB NO
CITY TEL NO
TRUNK PERMIT NO
STATE ^�
REGISTRATIO O ® COUNTY ROAD PERMIT NO max+
DESCRIPTION LOT NO �r R.25
11 of
STATE
ENCROACHMENT
BLOCK TRACT G y U INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT �2,�?�( I.ZS NOW ON LOTS CHARGES
USE OF
BUILDINGS /r/ _ CONNECTION CHARGE FEE
NO DESCRIPTION Or WOOK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER = 860 RECEIPT NO I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO DATE BY
SEWER!!!DISPOSAL SYSTEM too
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2J0 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
TYPE OFOONNECTION p FROM
OWNERS PERMIT = 1 Y C
00 B L M L TO
AUTHORIZATION TOTAL FEE I dly7ey _
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE AB DESCRIBED EXISTING qp Q'ALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO THE P 1
LIC SEWE
S16NED THIS _ DAY OF _ 95 NEW HOUSE SEWER ,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT' ^ _ _ BUILDING OR WORK
ADDRESS -1--.2 i AND/OR DRAINF ELD IT(S)
1 HEREBY ACKNOWLEDGE THAT I 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
ND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
ASTATE OF CALIFORNIA OR THAT IAM THE LEGAL OWN
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑n
SEERPIT(8)� CESSPOO90
SIGNATURE
OF PERMITTEE _ _ _ µ�- - -�
MORMOM
70A642D 663 1/68