HomeMy Public PortalAbout5423 PAL MAL AVE_Sewer__ DEPARTMENT OF COUNTY ENCHNEM SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
. � COU74W OF LOS ANGELES 2
WILLIAM J. FOX, CGuHTY ENGINEER I BUILDING 1/21 3 >R
FOR APtI.ICANT TO RLL IN LOCALITY �.
BUILDING NEAREST
ADDRE88 CROSS ST
LOCALITY�j OIBTRI 0 SERIAL NO / PERM
7ITNO
NEAREST
ST A S
RECEIVED BY BoOF fw IntoMie• DATE 1 E
OWNERMAIL
fp�n L S
ADDRESS �� USE ZOM OCCUPANCY YAP
RK PQ
CITY TELMO.
CONTRACTOR 60.IMP NO q
ADDRESS _� i JOB.110
CRY EL NO TRUNK PERMIT NOATE
REGISTRATION NO 6 COUNTY ROAD PERMIT NO
LEOAL / � STATE ENCROACHMENT
DESCRIPTION LOT NO / PERMIT NO
BLOCK TRACT T7(�9D INDUSTRIAL
�/ WASTE APPROVAL
SIZE OF LOT 7fx sw MO OF BLOTS /
/ MOW ON LOT C GEB
USE OF
BUILDI N88 L• CONNECTION CHAT EFE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FE
N U8 HEWER CON 1 M 0
PUBLICSEWER O • SSS RECEIPT•MO DATE I BY
MUSE SEWER CONNECTINGO
PRIVATE DISPOSAL SYSTEM 100
WORK TO HOUSE SEWER BLDG.OR 100 E%CEPT10 RECOflDED
ALTER ON REPAIR EXISTING NO ON BY
SEWER 08 DISPOSAL SYSTEM 100
DISAND/ORMECT OISSPOSAL SYSTEGAR M SEWER 1 00 CONNECTION ATA
SEPTIC TANK,SEEPAGE PIT ON
PITS AND/OR GRAINFIELD 240 STATION 3'� s DEPTH
CESSPO L-D ELL
SPECIAL CONDITIONS ONLY Z00 / AMH�OLFRREFERENCE LOWER'
TYPE OF CONNECTION LEMOTH FROM
M► L M L TO P L
OWNERS PERMIT $ I 00
AUTHORIZATION TOTAL FEE 1191,16-49
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN MANED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INBPECTOWSSIG ATURE DATE
DWELLING TO THE PUBLIC SEWE {'
SIGNED THIS-DAY OF 19.47 NEW HOUSE SEWER
OWNER OR -//�y/� CONNECT ADDITIONAL
OWNERS ABENT 11.(� BUILDING OR WORK
fJ ��y BEPTIOTANK.BEEP PIT(8)
ADDRESS L ` AMD IOR ORA NE ELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I H�EE�EJIRI(EBY CERTIFY THAT 1 AN PROPERLY REGISTERED
ERBO�THIC 80E 8 CUIR[D. Y _LO�OELEB UMTY DI�FOM HOUSE ST AND
�'I
818 URE EM NIIEE��BJE EEP PIT(8)o CESSPOOLS z- 7_1P
IN 0► TTE
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