HomeMy Public PortalAbout5208 PAL MAL AVE_Sewer__ '&E166 APPLICATION FOR PERMIT ],
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County of Los Angeles BUILDING rAZ
WM.J. FOX. COUNTY ENGINEER ADDRESS --
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL —. :1 �
R±PTION LOT NO. �. OWNER
rBLOCK Ti AC4212 v WAIL
NO.OFBLDGS.SIZE OE LOT NOW ON LO't CITY - NO.USEOp -
BUILDINGS - i
_ �y DISTRICT NO. GROUP I MAP
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BIC PG
CONTRACTO
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ADDRESS C, CONNECTION DATA
CITY L _..p.. STATION DEPTH
E} STATE MANHOLE REFERENCE
REGISTRATION N0. D COUNTY U "!- LO`N_F_R__
- ------ -- --� � TYPE OF CONNECTION LENGTH FROM
N0.1 DESUIPTION OF WORK FEE Y. CURB ... L. M_L.TO P.L. _
HOUSE SEWER CONNECTING TO
3.50
PUBLIC SEWER
�_$
HOU E SEWER CONNECTING TO
P RIV,ATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. - JOB, NO.
_ WORK TO HOUSE SEWER _ I,DO I _---
ALTER OR REPAIR EXISTING —
SENER_OR DISPOSAL SYSTEM 1.0.3 1 �— TRUNK PERMIT NO. ROAD PERMIT NO.
�Y DISCONNECT AND ABANDON __
SEWER ( STATE ENCROACHMENT
_ -
_ AND/O_R DISPOSAL SYSTEM —I:00 P_ERMIT NO.
SEPTIC TANK SEEPAGE PIT OR - - � 1NDUSTRiAL
PITS AND/OR DRAINFIELO 2.00 Il Y'%AS7E APPROVAL.
— �
CESSPOOL ORYWELL
SPECEAL CONDITIONS ONLY 2.00 s !
______i - _ -- �. CHARGES
-- —' — CONNECTION CHARGE FEE
0vVNERy PERMIT $ � t 00
— --— ----—_....-___---
AUTHORIZATION TOTAL FEE RF.IMBeasEMENT FEE .
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS 6AT[ INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _
-TO.THE PUBLIC SEWER
NEW HOUSE.SEWER
SIGNED THIS—:__-._..®.DAY 0,_ ----
OWNER OR CONNECT ADDITIONAL
OWNERS A.t.ENT.--`--_��._._.._.____:_._r,.�_.._._.„..-.a.-__....._-_ - _6UILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS-..:..- _ _ _ _AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION _CESSPOOL 0 DRYWELL❑
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, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY 'REGISTERED AND;'OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE BEV.^!D _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE .-�
DESCRIBED RESIDENTIAL PROPERT�;...'-_ ., BACKFILL SEPTIC TANKS EJ
�... .t' SEEP PITaSI ❑ CESSPOOLS I;J
SIGNATURE `�4—
OF PERMITTEE
WILLIAM J. FOX.COUNTY F-NGINEER VALIDATION
4 9 ? 91iXN- 4
BY BY
DEPUTY DEPU'YY
BY BY
0 DEPUTY DEPUTY