HomeMy Public PortalAbout5334 PAL MAL AVE_Sewer__ DEPAUTAIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEERRUILOING
ADORES
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rF�jOR APPLICANT TO FILL lIj)' NEAREST
LOCALITY SF
ADDRESS'S 7�2 X3/1[ ��(a �AF/�' CROSS ST.
LOCALITY
DISTRICT NO. SERIAL NO. PERMIT NO.
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NEAREST /!'S / L J� A ¢2 S�7 `T
CROSS ST. ED BZ Rcatly for Inspection DATE�IISSSUED
OWNERMAIL
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ADDRESS �,3..�� / AG[vl%/• IO��_I USE70NE OCCUPANCY BR ps
CITY 7— TELAO. -- ///
CONTRAC' IR �� I� ®�(:I ZA./C CO.IMP.NO. �Ap,
ADDRESS15'. L/ J0B NO.
J may' LLL
CITY E'A,0��, TELAO. /'�T / /`-7 • TRUNK PERMIT NO.
' REGISTRATION NO. l� COUNTY
ROAD PERMIT N0.
LEGAL STATE
DESCRIPTION LOT NO.lop PERMIT NOROACXMENT
BLOCK 14 TRACT 1� yy INDUSTRIAL fJ
Z.dt NO.OF BLDGB. WASTE APPROVAL '
SIZE OF LOT 7�1 NOW ON LOT CHARD 8
d�� J
USE OF
NGS �)(rL/C.�L ILr`''� � CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TOS
PUBLICSEWER Q $ 3.50 3 15'rRECEIPT NO. e I DATE BY
PHHOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER L00 L''
ALTER OR REPAIR EXISTING REL DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR 3
P17S AND GRAINFIELD 2-00
STATION x' 61" DEPTH �p
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /sjN MANXOLE REFERENCE
LOWER
TYPE OF CONNECTION LENGTH PROM
OWNERS I PERMIT S 3 DO '"" ARD- P.L. M.L.TO P.L. J
AUTHORIZATION TOTAL FEE Q 5(� ,4p I 'PA ss �— R
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TB THE PUBLIC SEWE
SIGNED THIS-AA Y !^' NEW HOUSE SEWER '
.DAY OF .._,�,_-.19 f`j
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.....:_... .. BUILDING OR WORK
ADDRESS...pl...t.�._Y....,=.L�✓._2.. .L'_tH':7.._---.—__._- _ SEPTIC TANK.SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL Q BRYWELL F]
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
HE COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
Atl0/OR LICENSED REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CA} RNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF TBE ABOVE, S/P�RIBED E IDENTIAL PROPERTY. BACKFILLSEPTIC TANKS[]
SIGNATURE V /�?,. � /�L"yf`Q�.G SEEP.PIT(S)[] CESSPOOLB�
OF PERMITTEE..._._....—.. .._.._.._._......__._.._.._.-__._...._.
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