HomeMy Public PortalAbout5734 NOEL DR_Sewer__ DEPAUT EWNT OF COUNTY ENGMEEB SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOIS Al GELES
WILLIAM J FOX, COUNTY EN13INEER BUILDING
ADDRESS _W')'72�+
�F�O'`�yR APPLICANT T,OfyJLL LOCALITY �r BUILDING
D RESS / 7 ®�V r CROSS 8T �1
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST 7P „ _O Q �i/� J A S\ --lo-S
CROSS ST Owe-+�� �w �+
ECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL �-3_�•"t
ADDRESS 4 ® ,,��, ' USE OCCUPANCY BK MAP PG
CITY TEL N Qot�/ -1 L _ I
CONTRACTOR 00'
CO IMP NO 3 1
ADDRESS
JOB NO
CITY 0 iTRUNK PERMIT NO
STATE
REGISTRATIO NO Ole a COUNTY ROAD PERMIT NO d(2i9 Sk 1
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO S" PERMIT NO
BLOCK TRACT .S- INDUSTRIAL
GF WASTE APPROVAL
SIZE OF LOT, NOW ON LOT CHARGES
USE OF /
BUILDINGS Sf✓ CONNECTIO RGE FEE
NO DESCRIPTION OF WORK FE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ! $ ago V RECEIPT NO BY
OUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDS OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 100
AND%OR DISPOSAL SYSTEMN SEWER 100 CONNECTION DATA
SEPTIC TANK OR
ISANODA) EZ 00 Ica
1
CESSPOOL-DRYWELL STATION 3-�- 5 DEPTH
SPECIAL CONDITIONS ONLY S 00 `�1 1 1 0 MANUPPEREFERENCE LOW
_ TYPE CURB CTION jEl T P LOM
OWNERS PERMIT ; 1 00
TO
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _ _ DAY OF 19— NEW HOUSE SEWER 3,�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ._y_� i,/�" _ BUILDING OR WORK
EPT'ADDRESS tl E r./f ��7FGt `M AND/OR DRTA AINF ELD EEP IT(8)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP CESSPOOL r 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 I AM PROPERLY REGISTERED DISCONNECT PLUS AND
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM GAL OWN
ER OF THE ABOVE D RIBED RIALOGNTINL PROPE BACKFILL SEPTIC TANOK
CESSP
SFPERISEEP PIT(q)� O ❑
OMATURE
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