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aeoBiEEv enol APPLICATION •FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELS BUILDING AND SAFETY '
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON GLt.�-la/ c,J —7 **7�
TRACTOR TO CONNECT THE ASOV[DESCRIBED EXISTINQ°WELLING 1 J Q 8A
TOTHSPUSLICSEWER
SIGNEDTHI9 DAY OF 1G_ # e e e e 1 Q
OWNER OR
OWNERS AGENT
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ADDRESS
I HEREBY ALKN 1308 THAT I HAVE READ THIS APPLICATION - e e B 1 8,0C)F
w!m STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMFLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
FLUM{INo AND s{wER{ -- 1 1. 14-78
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOB ANGELS{COUNTY AND STATE OF
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CAFORNIA OR THATIAMTHE L LEGAOWNER OF AND INTENOTO RE
SEN IN THE ABOVE DESCRNSD RSSIDBNTIAL PROPERTY
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es IEEvenol APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGERS BUILDING AND SAFETY
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BUILDING i y d Ay /
ADDRESS (-/
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LICENSE NO CLA36
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I HAVE AT THM DATE A CONTRACT WITH THE HERBU4NAMEDdD
V✓�`�A /TRACTOR TO CONNECT THE ABOVE D[SCMSED EXISTING DWE
TOTiE PUBLIC SEWER 21 3 O_4 A
SIGNED THIS DAY OF 19_
OWNSR OR • • • f 1 O
OWIICRS AGRNT _
ADDRESS 2 [ [ 1 8 0 0
I HEMET ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STAT[THAT THE ABOVE 15 CORRECT AN1 U O O V
D AGREE TO COMPLY • f
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING
PWM ERE ANDSEWERS
1 HERESY A CERTIFY THAT IAM PROPERLY REGISTERED AND/OR 11, 1 4 -78
LK:ENs[O AS THAT I D BY LOS AL O"E CO AN AND STAT[ R
CALIFORNIA ORTHATIAM THE REST OWNER OR AHDINTENDTO R[ _
BIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE
OF PSRMITT[