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TeAeuD APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENTE9
OF COUNTY ENGINE
BUILDING AND SAFETY DIVISION BU=
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HEAR BY
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OR APPLICANT TO FILL IN CRD{{ {T
PTION LOT NO OWNER
TRACT Y�sz 7-
No
SIZEr LOT NOW ON LOT@ CITY TEL NO
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CONTRACTOR !� (�'�A f�
ADDRESS CO C ON DATA
TEL Hp,J J•3 STATION DEPTH
An UPPER
RATION NO COUNTY YANNOL[R[I[R[NC[ ���
OESCRI ION OF WORK IEE TYPE or NN[CTIOM LENGTH FROM
OU{[SEWER CONNECTING TO Y P L ML TOP L d
UBLIC SEWER • SS oG
[PTI TANK SEEPAGE PI PC n0 O
ITS AND/OA GRAINFIELD • @1000 CO IMP NO "JOB NO V
OUBC SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
RIVATE DISPOSAL SY{TEM • Ba 00 O
ONNECT ADDITIONAL BL AFFIDAVITmv[ 4[u[RT RECORD INSTR NO DAT[
ORK TO HOURS SEWER • Ea00VERFLOW{[[FAO[PIT DRAINFI[LD
ETN CORE., ORYWELL MANHOLE• 95W G
ABANDON [ HWY OR" MORNING N
SEWEROMi{PotA►1YiRET1 • 000 Z
PENCROACHMENT
PERMIT
NO
MIINOUBTRIAL
WAR[wRROVAL
OWNER'S PERT ! 2 00 CHARGES
AUTHORIZATION TOTAL FEE a CONNECT CHARGE FEE
1 HAVE AT THIS DAT[ A CONTRACT WITH THE HERRIN NAMED CON REIMBURSEMENT PER
TRACTOR TO CONNECT THE ABOVE DESCRIBED METING DWELLING M RT•OVA3.�
TO THE PUBLIC SEWER ADAT[ INSPECTOR{SIGNATURE
SIGNED THIS DAY OF 1!_
OWNERoR HEW HOUSE SEWER
OW nus AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAANK KIE PIT(S)
AND/OR GRAINFIELD
AND {TATE THAT THE ABOVE IE CORRECT AND AGR[[ COMPLY
WITH ALL COU HTY ORDINANCES AND CTAT[ LAWS REGULATING
PLUMBING AND {[W[M CESSPOOL ❑ DIIYW[LL ❑
' HERB"
CERTIFYTHAT 1 AN PROPERLY REGISTERED ANO/OR ALTER REPAIR {EWER OR
LICENSED A{ R[OUIR[D BY LOB ANGLES COUNTY AND {TA OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LOCAL OWNER OF 1 D TO DI@CONNECT PLUG AND
RESIDE IN THE ABOVE D IBED RES EN O ABANDON HOUSESEWER •/
SIGN O
or P[RM CRIILL S[PUIC TANKS
SRP Frt ul U c[proou
VAIMATION ROBERT A WOOD
M O CASH SUPERVISING ROB MECHANICAL ENGINEER
Vy,o 5 9 8 8,J FEB 27 1 0 D 5.00-
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I T P
BUILDING .55!19 N Pte/ l✓ki/ %ye
CASSATD. GRIFFIN. SUPT OF BUILDING ADDRESS
FOR APPLICANT F LIN LOCALITY
BUILDING ( r/ NEAREST ADDRESS, Y �/, CROSS ST. DG//7CS r.'
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST S A 193 1&76 S
CROSS ST.
RECEIVED BY Ready for Inspection DATEISSUED
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OWNER ,V2l/ -- /-2 O-53
MAILZ USEZONE OCCUPANCY MAP
ADDRESS BK PG/ �+ 7�
CITY_ �.�I d �, ti.!` TELAO. K P.i ----
CONTRALTO ` l CHARGES REIMBURSEMENT FEE
j�,�3 0t
I n REQUIRED
ADDRESS .] 'I�t.00"
, J NOT REQUIRED
CITYv/�s 00 �� fi Cri TEL.NO. O L 3 e�__ JOB NO. —' CONNECTION CHARGE FEE
srA �nY ¢3
REGISTRATION N0. � ' CO.IMP.NO. � - ,4
LEGAL (' I RECEIPT NO. I DATE I BY
DESCRIPTION LOT NO. SI �p lvl
BL K TRACT F2_ WAIVER FOR RECORDING
SIZE OF LOT t�'I X y N0.OF BLOCS. RECEIPT NO. I GATE I BY
�. NOW ON LOT
UOF /p
s BUILDINGS TRUNK PERMIT NO.
NO. DESCRIPTION OF WORK FEE
PHOUSE
UBLICS EWEREWER CONNECTING TO S 3.50 I O ROAD PERMIT NO. --
e HOUSE SEWERCONNECTING TO I STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO.
_ CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER I.00 CC7 WASTE APPROVAL
ALTER OB REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 -. STATIONQ --DEPTH LJ
SEPTIC TANK.SEEPAGE PIT OR --
PITS AND/OR GRAINFIELD 2.00 I MANHOLE REEERE CE
CESSPOOL—DRYW ELL UPPER / / Q� LOWER _
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTION `LENGTH FROM
Y. CURB P.L. - 'M.L.TO P.L.
OWNERS PERMIT S i 1 00 -
ALITHORIZATION I TOTAL FEE I v �a
IHAVE THIS DATE CONTRACTED WITH THE HEREAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBEDI EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
-:
SIGNED THIS__..-.---_---_DAY OOWNER ORF
1_- NEW HOUSE SEWER'-.....-'--.__/-.-/.J-.--.19........ _ .,� -.
OWNERS AGENT._,-> ATL��-.1< /;_______ BUILDING OR WORK
AL
SEPTIC TANK,SEEP.PIT(S)
ADDRESS_.................._.........._....._._..........__....._........_....._...__..___, AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL d ORYWELL �/^ .�,�T-- >7
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
����"j��. SEEP.PIT(S)� CESSPOOLS E]
SIGNATURE ♦y ...........
76A642D 663 12/52