HomeMy Public PortalAbout5736-5736 1/2-5738-5738 1/2 NOEL DR_Sewer__ r
saaa ` APPLICATION FOR PERMIT
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Mm"TIMM OF coum Eton= SEWER SEWAGE DISPOSAL
BUUMG AND BAFM DMSION BUILDING
ADDRESS
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LEGAL
DESCRIPTION LOT N OWNER
BLOCK t TRA MAIL
I ADDRESS
0 OF BLDG
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDING DISTRICT NO GROUP YAP PROCESSED BY
BR PG
CO TOR �� •
ADDRESS MON DATA
CITY TEL N STATION 1A DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO COUNTY LOWER
NO I DESCRIPTION 07 WORK
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 41 8 00
SEPTIC TANK SEEPAGgg PIT OR TYPE OF CONNECTION LENGTH FROM rj
PITS AND/OR DRAINFIELD ! 8 00 Y CURB P L M L TO P L i!
OVERFLOW SEEPAGE P1T DRAINFIELD
EZTN CESSPOOL DRYWELL MANHOLE $100
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO JOB NO
WORK TO ADDITIONAL BLDG
OR $1 00 TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM f 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVER sPEDW E 00 CONNECTION CHARGE FEE
AUMOR A'1'ION TOTAL FSE REIMBURSEMENT FEE /I GrSf�L
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPEOV BATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED TH nY —19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 13 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY C TIFT THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICEN D AS EOUIRED BY LOS ELES C UNTT AND STATE OF ABANDON HOUSE SEWER
CAL
A RNIA R THAT 1 AM TN GAL OF THE ABOVE
DES 1B D NTS!,L Pip
BACKFILL SEPTIC TANKS
SEEP PITS CESSPOOLS 13
OF PERMI
®r _�IDATiON ROBERT A WOOD
os M o CASH tiUPBtiVItilNa 11fECHANICiAI.HNG1INIi8R
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