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HomeMy Public PortalAbout5232 PAL MAL AVE_Sewer__ 6A642063 APPLICATION FOR PERMIT i. COUNTY OF CLOS ANGELES DtPA.RTtv'ENT OF COUNTY ENGINEER SE'1/4 ER-S 1 G..E DISPOSAL BUILDING AND SAFETY DIVISION 10FN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sap't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CR© « 5T l v $ bESC:k.PTION 1_!`,T NO. 04VNC4 4 BLOCK TRACT f rtr �, : i .`% ADDRESS N. OF BLDGS: S(ZE OF LOT" NOW ON LOT CITY TEL. NO. USE OP--._—_--_ ."ROIfP MAP YRCCE55E.D VY BUILDINGS p, D'^�7RSfT NO. � _ ti -r IS 1'G b _ / r yam" CONTRACTOR g !� a r �r F d' .:_.: n�N 3 g-� ADbf#$T..aS" -' y �' ,_ COI�iI3OTIC?IV I)A3`&4.' - C7T1" r TEL, 'c0,'LL STATION D£ ,N '� y R G G H4770N NO , ��aTR,TE MANHOLE REFERENCE � _ f _ _ _ _ L rote rY �a . R.. 'NQ.�' �ESCf �N C3 WORK}� FEE _ __ TbPE,OF cy"hvrFtl'Ct,10N LENGTH FROM J 1 HOUSE SEWER CONNECT'Nov TO _— --- — —_ Y. I`URa i P.L. M,C,_TO P.�..:__ - / i PUBLIC SEWER @ $5.00 P.G.Pd O. _ PEPTIC TANK.SEEPAGE IT OR R _.'^� e'IT..AND/:)R DRA!N MELD 510,00hl P.SCY, l.. JI JOF;NO HOUSE S Vd K G STING TU l TRUNK PFRh4 7 NO RO AS's rF RATs7'NO. PRIVAT' DI pCSh{.SY>7F YvS C $5 Oa _ CONNECT AD✓i TSONA1...BLVGr.O.R2 --� Af FIDAV�7� WAiV}a CA.;.EMEN c.I RECORD.IN: .5TR ?.C. � DATE �.. WORK'TO HO'JSESE`WEft .. UVE6iPLON Sk"E:PAG r".PIT,].}'I'2'TIN F:LD EXTN,CESS POOL;DFRYWE LL,M A NH O LE.@ 5.5.00 ._--;- -� _. HWY..OR ST.WIDENING ALTFh.RLP P R OR ABANDON+ious SEWER OF OI POSA SYSTE A9 -___— ` 53.00 STATE ENCF{GACFI i�#E NT -' F RMIT NO. S"R:S,-E APPROVAL -: ERMIT 2' 00 `:ONN`E:CTiON CHARGE FEE AITI°°$IC,��ZF4.'�IC3 `.DOTAL E �' �` - - '9 }i A,VE AT 71115 D:eT'ce A CC3 N'e RACT \V i7H THE tiEREftS NAMEDCQN.- RE1MHi�s 'g;tv75Tp.('?i'sP_E TRACTOR i0 COi1 CCT.TILE ABOVF 0115CR6BED E)5'15TING. DWEi.LIN --.— yy�g—g �q,yy a[g�—++___._�._.. _—r 70 THE PUBLIC SL dV Er'Ft.,. 3 .. A��"��tlALia� DATE FIN.F'ECTO., 1GNAIURF, SIGNED 'THIS ,,�' CLAY ¢P--_� ,� OW'NE'R OR ', N>-••14 HOUSE SEWER. OWNERS AGENT_ _ --.-- _ _-_. CONNECT ADDIT!4NA_I„ ADDRESS BUILDING OR WORST - — -- SEP IC 7dNl' SEEP, ITIS I HEREBY ACKNOWLEDGE THAT I HAVE RFAO THIS APPLICATION S r n.0 R DR A I N r..I E I-D ANSJ 5 ATEE THAsT THE ABOVE IS CORRECT' AND AGREE TO COMPLY WIT I_! AL:, COUNTY C)ROINANCIES AND STATE. LAWS REGULAY1N.G Flea R9 BING AND SEW RS E G L �� DRY'WE LL I HERE CERTIFY Tr7A7,.1 .S.N PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICEP.„D A`: REQUIRED BY L03 AN'LES COUNTY AND STATE. OF SEWAGE DPOS LSYSEM -+ C ALIFORNIA OR THAT I AkY THE LE.CAL OWNER. OF, ANO'INTE'ND TO Oisc-SNN£.C.f PLUG Af±lJ RP.:I✓ IN.. TN ASO,',;E'pES RigED a S,IDPNT(.AL_ l°11 SL,3' RT'Y pBAM°.;10N HOUSE SEWER SIGN AT URF. OF PERMITTEE L •'�” 'I J y _ EtACKFiLt SEPT' '-J SEEP,P TITS) [.] "55POOL5 i! VALIDATION- ROBERT A. 06 cx: M.O. CASHSUPERVISING MEC*{ANI6:AL ENC,tT:I'E.R