HomeMy Public PortalAbout5528 PAL MAL AVE_Sewer__ DEPAIUVAIENT OF COUNTY ENGINEER SEWER-SEWAGE- DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER ADDRESS
FOR APPLICANT TA FILL IN LOCALITY
BUILDING �1��_ /j7 / l�Q NEAREST
ADDRESS J �.7 LSC:{_/ CROSS ST.
LOCALITY r DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST �. / A g_'.' /.2 S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS -USEZON OCCUPANCY MAP
BK PG
CITY TEL.NO.
CONTRACTOR CO.IMP.NO.
ADDRESS �i Z
JOB N0.
CITY TEL.NO. 2/ TRUNK PERMIT NO. --
❑p STATE
REGISTRATION N0. -74�� �/J � C� �� g.aNwrt ROAD PERMIT NO.
LEGAL : 6• G �'
DESCRIPTION LOT N0.N N lx_ 3-2— STATE ENCROACHMENT
PERMIT NO. - -- -
BLOCK TRACT F✓�� �_-F'... .�, -/ INDUSTRIAL
PROVAL '-
SIZE OF LOT , Z! NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONN ON CHARGE FEE _
NO. DESCRIPTION WOR C FEVF
HOUSE HOUSE SEWER CONNECTING TO ��
PUBLIC8EWER a $ 5.50 RECEIPT NO. TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R-ECORQED
WORK TO HOUSE SEWER 1.00
ALTER ORREPAIR EXISTING ND- I DATE .-f-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 GRAINFIELD 2.00 STATION 3 V/ DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 oMANHOLE REFERENCE
,3 S a' UPPER
TYPE OFc uu ME TI LENGTH FROM
OWNERS PERMIT $ 1 00 sP.L. M.L.TO P.L. -U
AUTHORIZATION TOTAL FEE / SZi
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING.
DWELLING TO THE PUBLIC SEWERAPPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS----_.-.-..------_DAY OF..-___._—_..__._..19_.__ NEW HOUSE SEWER S
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT........_.............__.._._._.._......_._..___.._._..._ BUILDING OR WORK
ADDRESS_.............____--------._-- SEPTIC TANK.SEEP.PIT(S)
" ...._._.._-__._.._.._._..._._.._.."..._. _ AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] ORYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO 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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E
ITTEE.. .-- S- .--- SEEP.PIT(S)Q CESSPOOLS •y-.+.-q! /-')o
SIGNATUIGNATURE -.
OF PERM
76A642D 663 1/53 -