HomeMy Public PortalAbout5557 PAL MAL AVE_Sewer__ ""A'°
e° APPLICATION FOR PERMIT 1
cESOR•R COUNTY OF LOS ANGEIFB
SEWER—SEWAGE DISPOSAL
DEPASTtIENT OF COUNTY ENGUQ=
BUILDING AND SAFETY DIMON RuILo1RG
roma A. LANBIB CeuVt m,m..: AODR
cAaAlr D. aaaPaa,soa'1 of slmdhM LOCALITY
NEAREST
FOEAPPLIC CROSS BY
LEGADESCRIPTION NO OWMER
BLOCK TRACT RR MAIL
DDRESS
NO
OF BLDOS
SIZE OF LOT NOW ON LOTCITY TEL NO IsTJ
USE OF
SUILOI RGS DISTRICT NO GROUP MAP ROCESSED
BR PG
CONTRACTOR Able Constr. 9
i
ADDRESS CONNECIION DASA
CITY El M nt8 TEL NO G STATION Z DEPTHSTATE >
REGISTRATION NO l6S COUNTY MANHOLE REFERENCE T� UPPB
NO DESCRIPTI NOF WOR PEE .
OUSE SEWER CONNECTING TO L
ppU BLIC SAEWE0.EE E S 00 ��
PETP'8 AND/OR ORAINR�ELOIT OR S OF CONNECTION N N FROM
EE EE �� F1 T CURB P L Y TOP L
OEXTNF CESSPOOLADR PTWELDL MAN HOLfi S 00 EL
HOUSE SEVER CONNECTING TO P C
PRIVATE DISPOSAL SYSTEM 100 CO IMP NO JOB
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER 100
�� Y HOUSE 1 0 STATE ENCROACHMENT
P MIT NO
S;WR INDUSTRIAL
WAST APPROVAL
CHANCES
OWNER'S PERMIT 2 00 CONNECTION CHARGE FSI
AUTHORIZATION TOTAL FEE zJ REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN ED CON. OVALS DATE INSPECTOR SSIGNATURB
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLIRG
TO THE PUBLIC SEWER
SIGNED THI AY Ip_ NEW xoosE SEWER
OWNER OR CON NECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADO AMD/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPU CESSPOOL DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLT REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
DESCRIBED RCALIFORNIA 681DBMTT 1780 THE LEGAL OWNER Of THE ABOVE BACKFILL SE IC TANKS❑ II q rC
SIGNATURE SEEP PIT D CESSPOOLS 6
OF PERYI
Or VAIMATION— ROBERTA WOOD
CK ■ 0 Vote SUPERVISING MECHANICAL ENGINEYR
LACO87O —� Aut 61 o A 8 C 0
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