HomeMy Public PortalAbout9629 VAL ST_Sewer__ L i
GYGD.II.Of APPLICATION FOR PERMIT
1
COUN" OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMM OF COUNTY ENGUMM -
BUILDMG AND SAFETY DrIMON [UILDIKG
) 0 $p � DR �!
CJlEBBT[A CIRUM. 9�4 d B ldl w LOCALITY
FOR APPLICANT TO FILL IN
"EA
r
LEGAL
DESCRIPTION LOT YO OWNER -
BLOCK TRACT ` MAIL
ADDRESS
y NO OF BLDGS
R
! E OF LOT /F/ NOW ON LOT CITY TIL NO' 1 _
USE OF
BUILDINGS DISTRICT NO GRDUI . YAP
CONTRACTOR Z j/� IO 7 1 Ar
' P
ADDRESS CONNECTION DATA
CITT TEL NOM.-F ` STATION D DEPTN
46 Ir-` COUTNTY MANHOLE REFERENCE UPPER
REGISTRATION NO LOWER
NO I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER cp TYPE OF CONNERIO LENCTX FRO■
SEPTIC TI�NK SEEPAGE PIT OR Y CURB L Y L TO P L
PITS AND,
DRAINFIELD 300
OVERFLOW SEEPAGE PIT DRAINFIELD
EZTN CESSPOOL DRYWELL MANHOLE 200
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR '
WORK TO HOUSE SEWER 1 00 TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM SI 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PEBMIS 00 CONNECTION CHARGE F[6
AUTHOMUTION TOTAL Fee REIMBURSEMENT FEE
I HAVE AT CON
TRACTOR To THIS
ONNECT THE CONTRACT
BOVE DESCRIBED EXISTING ADWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNEDTHI DAY OF 19— NEW HOUSE SEWrn Z
OWNER Ofl- - CONNECT ADDITIONAL
OWNERS AGEKT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(!) -- - -•---HOUR DRAINFIELD
w
1 HEREBY A NLEDOE THAT 1 HAVE READ THIS APPLICATION
AND BATE THAT THE ABOVE IS-CORRECT-AND AGREE E COMPLY CESSPOOL DRYWELL - - - '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR,SEWER OR
IXEREBT CER71rY-TRAT I AM PROPERLY RE ED AND/OR SEWAGE DISPOSAL SYSTEM-
LIC EENSE,
YSTEM-LICENSED AS REQUIRED BY LOS ANGELES C ANO STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1_ THE, LEGAL _OF .THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI ROP BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT ! CES9POOLS OF FERMI
mr - ALIDATION ROBERT A-WOOD -
- - - C[ ■ o CUN SUPERVISING MECHANICAL ENGINEER -
- Liz 2 i 1rn JAN 27 i 0 A 500 4