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HomeMy Public PortalAbout5111 PAL MAL AVE_Sewer__ ^.© S&F-01 -063 3.55 APPLICATION FOR PERMIT 5&E•fi3 .... DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL g Deportment of County Engineer County of Los Angeles BUILDING WMI.J. FOX,COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUP`r of BUILDING LOCALITY FOR APPLICANT TO PILL IN NEAREST LEGAL - DESCRIP"CION LOT NO. OWNER BLOCK -- TRACT - MAIL NO. OF BLDGS. — S17C OF LUTNOW ON LOT - CI7Y TEL. NO. USE OF -- _- - �k „'`` "Jar'f DISTRICT N0. -i GROUP MAP BUILDINGS M1 1rr� g-.i r� it -- -- — SK PG CONTRACTOR r ,.—._-.° I ADDRtS*' '" `..- _ — —.._.-CONNECTION DATA CITY' d' �.V i :'/�. TEL. NO. ---�— --- _STATION DEPTH —A L STATE MANHOLE REFERENCE - e'-e REGISTRATION NO, [] COUNTY __—.—__. _ V�_ �-LOWER_j _ N0. DESCRIPTION OF WORK -- FEE T ---'— ----- _ _ _ --- _.--- -` ---•---- TYPE "IhECT[ON LENGTH FROM HOUSE SE VER CONNECTING TO Y, CLk8 P.L, M L TO P.L. 3-D --- �� HOUSE SEVIER CONNECTING TO i --� PRIV ti TE_DISPOSAL Y TENNI 1.00+-,. CONNECT ADDITIONAL BLDG.OR � P C NO, WORK TO HOUSE SEWER__ I,D9 _co:_Ih Y NO JOB-N_30tS N6,-..--` A'TFk OR REPAIR EX1 TING i ERMIT NO. SL d-.,R OR DISPOSAL SIST_EM 1.00( ._ TRUNK ROAD PERMIT NO./C t, y �� DISCONNECT AND ABANDON SEWER i�-� STATE ENCROACHMENT -- AND/OR D 5POSAL SYSTEM PERMIT NO 1 j SEPTIC TANG SEEPAGE PIT OR - _ -`_.___---___ --- PITS -PITS ANDi ORDRAIN IE'D 0� INDUSTRIAL - C SSPOOL DkY\v WASTE APPROVAL ELL - I SPECIAL COr'DiT[Oh�ONLY 2,00 CHARGES OVVNEFi'S PERI MIT �- coNNEcr10N CHARGE FEE _ is �o AUTHORIZATION I TOTAL EEE i REIMBURSEMENT FEE I H YE THIS DAYE CONTRACTED WITH THE E L:REIN NARFD CON- c TRACTOR TO CONNECT THE ABODE DESCRIBED EXISTING D f: LSNG APPROVALS I DATE INSPEc'rO2'S SIGNATURE TO THE PUBLIC S `R ER ---'--- NE V HOUSE SUMER SIGNLD THIS ------- OF__—, CONNECT ADDITIONAL 014'NLR OR BUILDING OR YORK OWNERS ADDRESS__.,., SEPTIC TANK,SEEP. PIT(S) - ----.- - _=_.,__...--._-_: '�; r:�=---_ •:� AND/OR DR_AI_NFiE_L_D_ I H P,EBY ACKNOWLEDGE_)THAT 1 HAVE READ THIS APPLICATION CESSPOOL ED DRYWELL JD�__. _-- AND 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. ALTS GE DISPOSALR SYSTEMR _ I HEREBY CERTIFY THAT' I AM PROPERLY REGISTERED AND/OR SEWAGE LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SE6VER ����- DESCRIBED RESIDENTIAL PROPERTY, - F _ -r 4da&6 $ /7441*4*0 SEEP. 0 CESSPOOLS SIGNATURE OF PERMITTEE yAtel� 1!5uc` WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF FLEG. INzPEc'r0R