HomeMy Public PortalAbout5233 PAL MAL AVE_Sewer__ DEPARTAIENT OF COUNTS ENGINES SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUELDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS "GEI" .
WILLIAM J. FOXr COUNTY ENGINEER BUILDING
I ADDRESS if'g IFY A AW -OVA A
FOR APPLICANT T FILL" IN LOCALITY
BUILDING 3 3 NEAREST a
ADDRESS d CROSS ST.
LOCALITY •, DISTRICT NO. Ready for Inspection PERMIT NO.
NEAREST S
CROSS ST.
�jRECEIVED BY DATE I ISSUED BY DATE
OWNER ®/• ,��f' i 'S
MAIL ADDRESS USE ZONE OCCUPANCY BK MAP PO
i
CITY N0:
CONTRAC R
CO.IMP.NO. 0�• �'Ir
ADDRESS
42 62-1 JOB N0.
CITY
TRUNK PERMIT NO.
REGISTRATION H0. / ® COUNTY
ROAD.PERMIT N0.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTY /8ljNNOO.WOOFBLODGS.
/ CHARGES
USE O
BUILDINGS !C " [1, �� ,c�+ CONNECTIO ARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FE
PUBLIC-SEWER W S' 3.50 RECEIPT NO. i� E BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDO.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00 .
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER'
_ AND/OR DISPOSAL SYSTEM 1.00. CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION Zo t 74 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS'ONLY 2.00 Qj ANN E EFERENCE. Loma
TYPE OF CONNE TI LENGTH FROM /
OWNERS PERMIT = I Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEEl
I 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 THI .DAY OF� 19 � NEW HOUSE SEWER ! �Z "Z .✓
OWNER OR CONNECT ADDITIONAL
OWNERS AGENBUILDING OR WORK
ADORES 8:; .-1 ,' ,__• SEPTIC TANK,SEEP.PIT(S)
AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE R AD THILt- CESSPOOL I] DRYWELL
IS
CATION AND STATE THAT THE ABOVE CORRECT AN A REE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED-
AND/OR.LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AMT E LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESID5,RT4AL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE //p SEEP.PIT(S)r] CESSPOOLS
OF PERMITTEE__1.1�GG-- _
76A642D S&E 663 4/54 J r