HomeMy Public PortalAbout5548 PAL MAL AVE_Sewer__ 76A 04E0•COfO•-10.71 APPLICATION FOR PERMI
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION EUILDING
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OWNERS AO[ OILDIN ADDITIONAL
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AND {TAT[ TNAT TX[ ABOVE I CORRECT AND AOR[[ TO COMING
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INUM•ING AND {EWE"KA.M
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DEPARTMENT OF OOUNTY ENGEgEEB S SWAGE DISPOSAL 1
DIVISION OF BUnMING AND SAFETY -j PERMIT APPLICATION
COUWTY OF L08 ANGELES
WILLIAM J. FOX. COUNTY ENBIN[[R ADD E{8
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NO DESCRIPTION OrJ WORK FEE REINSURB[M[
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PUBLIC SEWER 06 0.60 RECEIPT MO E BY
HOUSE SEWER CONNECTING TO
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ALTER ON REPAIR EXISTING No DATE SY
SEWER OR DISPOSAL SYSTEM IDD
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OWNERS PERMIT $ I I DD Y CURB P L M L TO P L
AUTHORIZATION I TOTAL FEE I ZOO
1 HAVE THIS DATE CONTRACTED WITH THE IBEEIN NAMED
G APPROVALS INSPECTOR'S 810MATURE DATE
DWELLING T TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _ ___ DAY OF _ _Iq— NEW HOUSE SEWER L _ •6 (j
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ __ _ .__, _ __._ BUILDING OR WORK
6EPTIC TANIL BEQ►.PIT(8)
ADDRESS _ __ _ _ _ _ __ _ _ _ _ _ _ _ _ AMD DR DRAIMFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYW[LL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL OOUNTY ORDINANCES AND STATE LAWS ALTER REPAIR BLW[R OR
REGULATING►LUMBIN AND SEWER& BEWABQ DIS►O�IIEWEBOR
1 HEREBY CERTIFY THAT 1 AN PROPERLY M[BI6TERED SMAC DISCONNECT PLUS SYSTEM
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STAT[ OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY RACKIFILLUPTICTANKS
BEEP PIT(S) CESSPOOL�
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