HomeMy Public PortalAbout5119 PAL MAL AVE_Sewer__ DEPARTMENT of COUNTY ENGIIUER �- ' -SEDER—SEWAGE DISPOSAL 1
' DIVISION OF BUILDING AND SAFETY ,ti PERMIT APPLICATION
COUNTY OF LOS ANGELS.
BUD'No
WILLIAM J. FDX; COUNTY ENGINEER ,I_ADDRESS�j/�
FOR APPLICANT FILL. N LOCALITY a�:
BUILDING �` NEAREST @�
ADDRESS L� CROSS ST. � /'
LOCALITY' DISTRICT 110. SERIAL NO. PPERRjMIITT NO.
NEAREST. �S� °� �d'f��.0=1� � A // / / Z S.
CROSSRE�Et '8 Ready for Iriepeotion TE,ISSUED
• OWNER ;,��!(//�� G✓p Wd'^
MAIL __�I �,, /f USE ZON OCCUPANCY BK MAP PG
ADDRESS •f f � GrX� GV�� _
CITY' TEL.N C t i(v A7-1 I
CONTRACTOR , ® 9
CO.IMP.N0.
ADDRESS JOB;NO.
_CITY T N0. TRUNK PERMIT NO.
REGISTRATION NO. ,�^ f COUNTY ROAD PERMIT No. -25
LEGAL 4"'
DESCRIPTION LOT NO. STATE ENCROACHMENT -
PERMIT N0. -
BLOCK'.: TRACT / �j INDUSTRIAL
+++ WASTE APPROVAL
BLDGS. CHARGE
SIZE OF LOT r NOW 0 LOT.
NO.OFIBUILDINGS G° ,�/ e&4 CONNECTION CHARGE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC
SEWER' ! S 3.60 RECEIPT NO. ATE BY
.:HOUSE SEWER CONNECTING TO I
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR /l®' CEPTION R RDED
WORK TO HOUSE SEWER 1.00 V
ALTER OR REPAIR EXISTING ' I DATEI BYSEWER.ORDISPOSALSYSTEM I.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00. CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00-1STATION ���� LjI DEPTH
CESSPOOL—DRYWELL O
SPECIAL CONDITIONS ONLY 2.00 �® ANH�OLLEE REFERENCE LOWER
TYPE 0ECTION LENGTH FROM y
OWNERS PERMIT ;_ I 00 !CMR 401ft M.L.TO P.L. �J
AUTHORIZATION TOTAL FEE ,
1 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_. _DAY OF,. Igort NEW HOUSE SEWER• yp��: „
OWNER OR CONNECT.ADDITIONAL _
OWNERS AGENT., _E :.._ ��� BUILDING OR WORK
_ _.._. ;
SEPTIC TANK,SEEP.-PITS)
AND/OR DRAINFIELD
-1"HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL-I- • CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO'COMPLY WITHALL COUNTY-
ORDINANCES AN STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS., SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
-AND/OR LICENSED-AS REQUIRED BY LOS ANGELES COUNTY ABANDON HO USES EWER
AND STATE OF CALIFORNIA OR THAT 1 RE LEGAL OWN•:
ER OF_THE ABOVE DESC ED REST TIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE -SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE..._
76A642A 662 7/53