HomeMy Public PortalAbout5559 PAL MAL AVE_Relocation__ CES061 -03 ) APPLICATION FOR P MIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION QUILDIN
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IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON R[IMSURSEM[NT FEE
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TO THE PUBLIC SEWER APPROVALS DAT[ INSPECTORS IONATURE
SIGNED THIS DAY OF I9_
OWNER ORNEW HOUSE SEWER
OWNERS AD", CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK SCEP PIT(S)
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STAT! THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING CESSPOOL [IDRYW[LL [jPLUMBING AND SLWERD
I HERESY C[RTIPY THAT M PROPERLY REGISTER AMO/OR ALTER REPAIR S[WQR OR
LICENSED AS R..UIRE. B S ANGLES COUNTY AN STATE OF SEWAGE DISPOBAL SYSTEM
CALIFORNIA OR THAT 1 [ LEGAL OWN OF AN INTEND TO DISCONNECT PLUG AND
flESIDE IN THE ABOV RIOND R[SID A PR CRTY ABANDON HOUSE SFW[R
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OF PERMITTEE 8[CP PIT(S) ❑ CESSPOOLS
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f oollIO APPLICATION FOR PERMIT
cteoe a ■e COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPAHTNIIDiT OF COUNTY HN(I]Xffi
BDJLDING AND SAFETY EMMON BUILDING 'S S
f0>� AL 66!®x. Comty >�v ADDRESS
CASSATT D GMFM, el@v of BRDiy LOCALITY
REAFOR ANT T CROSS
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DESCRIPTION a°i