HomeMy Public PortalAbout5509 PAL MAL AVE_Sewer__ 1
DEPAKTBI OF COUNTY ENGMEM SEWER—SEWAGE DISPOSAL!_.`
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COMMY OF LOS ANGELES
- WILLIAM J. FOX. COUNTY ENGINEER BUILDING u
CABNATT D. GRIFFIN BUPT OV MUILGINY ADDRESS-_ 5511 / Xl ,/�q�
LOCALITY -
` FOR APPLICANT TO//wFIL IN Pm
BUILDING
, L� �� NEAREST
ADDRESS CROSS ST. O/1"YCS 7
LOCALITY ' S- � ��— DISTRICT NO. SERIAL NO.
PERMIT NO.
NEA—REST G� A �I7IA1/ I " S
CROSS SL G' RECEIVED BY Re0dy for 1N000011on DATEISSUED
OWNER 15-e�� I q-2-3- ,
MAIL -O USE ZONE OCCUPANCY MAP
ADDRESS BE
PG
CITY (-
2,� =VS& TEL.NO-
CONTRACTOR CHARGES REIMBURSEMENT FEE
REQUIRED
ADDRESS �, /
"✓� NOT REQUIRED
CITY TEL.NO. �� .-Gya' JOB NO. CONNECTION CHARGE FEE
2 rpy STATE 00.IMP.NO. /T7——/ F8p
REGISTRATION No.�,.Z�/p j O OSYN?1— RECEIPT NO. I DATE I BY
LEGADESCRIPTION LOT NO.yZ�Ilf f %10 4`L dd7 / _-
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOT r�J x J�'Q NOW ON LOTS RECEIPT NO. DATE BY
USE /J. r d
BUILDINGS (/(w6. / �� TRUNK PERMIT N0. ---
NO. DESCRIPTION OF WORK FEE
H O USE SEWER CONNECTING TO _.� ROAD PERMIT NO.
/ PUBLICSEWER f $ 3.00
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT -- -
PRIVATE DISPOSAL SYSTEM 1,00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL -
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION f-l/�, DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 MANHOLE REFERENCE _
CESSPOOL—DRYWELL t)PPEQ— --'- LOWER 4�2'- -
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTIONLENGTH FROM -
Y. CURB - P.L. M.L.TO P.L.
OWNERS PERMIT f I I o0
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIQNATURE DATE
DWELLING TO THE PUBLIC SEWER
SR
SIGNED THIS..�..I...it-r..DAY OF---Il!_._R-1 L._-_-..--. NEW HOUSE EWE
19-�- -
CONNECT ADDITIONAL
OWNER OR / (Q ,�D''� BUILDING OR WORK
OWNERS AGENT [ ..t.4..__.f ^...'^'rS--r_..___.._.__._.
,.L� - - SEPTIC TANK,SEEP.PITS)
ADDRESS......4..Y-_�Q...-.N:_.i:-A.+aj4jA_AL.-JNl-dti,-.......--- ANO/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I NAVE HEAD THIS APPLI- CESSPOOL E] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY LDON HOUSESA ER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
' ER OF THE ABOVE,DESCRIBED RESIDENTIAL P-OP RTY_ FIIILSEPTIC TANKS
SEEP.P �'-
SIGNATU
IS OF PERMITTEE .. ...
76A642D 66282/52