HomeMy Public PortalAbout5610 PAL MAL AVE_Sewer__ 71
C11008.6 u 7 APPLICATION FOR PERMIT 1
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTbUM OF COUNTY MGN=
BUBJMG AND SAFETY DrMON BUILDING
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JOHN A. IABIb DCounty BaGlu�e
CASSATT D O MITM, Sap t of BuDdtnp LOCALITY
NEAREST
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LEGAL
4-0
DESCRIPTION LOT NO GFNOI
BLOCK TRACT f MAIL
ADDRUS
HO 0 BLDGS
312E OF LOT S NOW ON LOT CI TEL NO JVo A 911
USE OF
BUILDING! DISTRItt NO GROUP YAP FROCKSSED By
CONTRACTOR Constr. � BK PG
ADORES! 22 W. Bryant Rd. CONNE ON DASA
CITY 1 Monte TEL NO G STATION DEPTH
REGISTRATION NO 168 STATE MANHOLE CK UPPER
NO UUD DESCRIPTION F R FEE LOWER
PUBLfCSS PRCONNECTING TO S
gEPTIC T EINYKEE SEEPAGE PIT OR TTPE OF NNECTION LENGTH FROM
PITS AN DIOR gDgRAT NggFIE''TTL�D Lp S 00 T CURB P L Y L TO P L
QTN LCOE99FEOOL UNTMELL YA NXOLfi E 00
HOUSE SEWER CONNECTING TO P cW
PRIVATE DISPOSAL STSTEY 1 00 CO IMP NO No
WO�}}RK TO HOUSE ENAL BLDG OR 1 00 O TRUNK PERMIT NO ROAD PERMIT NO
SEWER OR DISPOSAL SYSTEM HOUSE 1 00 STATE ENCROA NT
PERMIT RO
1.11DU AL
PPRO A
CHARGES
L
WNWs �T 2 00 CONNECTILN CHARGE FEE
HOBMTION TOTAL FEE Q REIMBURSEMENT FEE
IYS AT THIS DATE A CONTRACT tl1TH THE NEREIN NAMED CON APPROVALS OATH INSPECTOR 8 SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
THE PUBLIC SHtlBR
ED THIS DAY OF IB_ NEW NDusE SEWER
R OR CONNECT ADDITIONAL
ERS AGENT (1,o BUILDING OR WORK
S�
SEFT7C TANK SEEP PR(!)
ADD AND OR ORAI NFIELD
HEREBT ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
STATE THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
ALL COUNTY ORDINANCES ApD STATE LAtl! 6EGULATINO ALTER REPAIR SEREROR
BING AND SEWERS SEWAGE DISPOSAL SYSTEM
NEREBT CERTIfT THAT AM P�tLT REGIlTERED AND/OR DIlCONREtt PLUG AND
NlHD AS REQUIRED LOS G COUNTY AND !TATE OP ABANDON HOUSE SEWER
FORNIA OR THAT I Ttl LEG L OtlMII Of TYK ABOYBRIBED RESIDE11T1 Pie BACKFILL CTANKS❑
ATURE BEEP PIT 9 CESPER
0. VALIDATION ROBERTA WOOD
■ G GAiK SLURKNVISING MECHANICAL ENOINEER
M 1 1 a 4 A AM 12 1 p A 4{3 O X