HomeMy Public PortalAbout5563 PAL MAL AVE_Sewer__ 78A84ID-BB APPLICATION FOR PERMIT
C E60 1
COUNTY OF LOB ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGnCM
BUILDING AND SAFETY DIVISION eooeni 3 LC j�jyLL
OHN A LAb81E. Ct® EB SST
A. 1015EN. Sup i of aUdmv
LOCALITY
NEAR EST I/
pA..R
OR APPLICANT TO M IN C=. ST LEGALV
TION LOT NO OWNER ((//
sT MAIL
TRACT ` ADORES{ Q / Q ���
NO Or BLOO{ �7/O
LOT NOW ON LOT CITY TEL NO
DISTRICT NO GROUP I MAP PROCESSED BY
G{ / BK PG
CTOR p/ �/,r/(/ D CONNECTION DATAT[L D..,S - 7Z 3 3 STATION 'J DEPTH
,� L�� COUNTY STATE MANHOLE REFERENCE / LPERATION MO O�'�/ 6 /DESCRIPTION OP WORK PEE YYPEOI o ECTIOM LENGTH FROM
U{R SEWER CONNECTING TO T R PL TO P LBLIC SEWER u So ou O y
SEPTIC TANK • PAD[FIT OR CO IMP NO JOB NO O
PITS AMO/OR DPAIMFIELD 0 11000
GUS[SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DIEPO{ALtY{TEM 0 Bi00 Dt
CONNECT ADDITIONAL[ OR AFFIDAVIT RM[[[ [[[[RESIT RECORD INSTR NO TE O
WORK TO HOUSE SEWER O 82M r
OVERFLOW SE[PAOE PIT OPAINFI[LO ILYJ
�{LTN.0 EESWSPlOOOOLRORYMIELL ABAnOOMAN MANHOLE $500
{500 NWY ORST WIDENING N
SE RR OR
11 p1YG{K1YM[M O S..
Z
STATE ENCROACHMENT
FSRMIT MO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT s E o0
AUTHORIZATION TOTAL FEE connESTIOM c of FEE
1 HAVE AT THIS DAT[ A CONTRACT WITH TN[ N[11[IN NAMED COM REIN{YR M[M Rf
ioATttiliRPuoeL�coiiwERTHE .eovE DESCRIBED [RunnG DwnuMO APPROVALS DATE INVECTGR•uon.ruRE
SIGNED THIS DAY OP Ip_
OwNER oR NEW Houma Sew"
OWNERS AO[NT CONNECT ADOITIOMAL
ADDRESS BUILDING OR WORK
I MERReY ACKNOWLEDGE THAT I HAVE READ TNI{ APPLICATION AND/OTAMK at"IE PITIq
AND STATE THAT THE ABOVE IS CORRECT AND AORER TO COMPLY AND/OR GRAINFIELD
WITH ALL COUNTY ORDINANCES AND STAT{ LAWS REGULATING
PLUMBING AND SEWER{ CESSPOOL ❑ DRYW[LL ❑
I N[R[BY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR S[W[R OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT JAM
THE LEGAL OWNER Or D INTEND TO DISCONNECT PLUG AND
RESIDE IN [ ABOVE D[S Io[D R[SID OPRATY ABANDON HOUSE SEWER
•IGNATG 61
BACRIIIL S[P�IC TANKS ❑
OF PERF BEEP PITI/1 U CESSPOOLS
VALIDATION ROBERT A WOOD
CK M O CASH SUPERVISING MECHANICAL ENGINEER
V,U0 5 9 9 O:Z FEB 2'7 1 ') D 5.0 0- C.
O"A40(11