HomeMy Public PortalAbout9737 VAL ST_Sewer__ DEPAUTMENT OF COUNTY ENGUC= SEWER-SEWAGE DISPOSAL 1 �,
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES 6
WILLIAM J. FDX, COUNTY ENGINEER I ADUD REILDINOBS
R APPLICANT TO RLL IN LOCALITY
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LOCALITY 1♦.}.^Y1�," e��y DISTRICT NO SERIAL NO PERMIT NO C
NEAREST fes/ /✓� A a / 03/ `T
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RECEI EO BY BCaAY for IotOeoNoa DATEISSUED
OWNER -.> -s¢-
MAIL / / w USE ZONE OCCUPANCY -*
ADDRESS L/ Y� p RIC PO
CITY � TEL NO /�-I L - �
CONTRACTOR 33.2 38
CO IMP NO �
ADDRESS Q
JOB NO �---��
CITY TEL NO -ev?1�Y TRUNK PERMIT NO ------
REGISTRATION STATE
REGISTRATION NO v ROAD PERMIT NO
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DESCRIPTION LOT NO LEGAL p Ili Q yL- STATE ENCROACHMENT
PERMIT NO
BLOCK , TRACT ly
USTRIAL
-- STE APPROVAL
SIZE OF LOT MO OF BLOBS
NOW OR LOT _CHARGES
USE OF
BU ILDINOB NNECTION CHARGE E
NO DESCRIPTION OF WORK FEE MBURSEMENT FEE
HOUSE SEWER CONNECTINGTO
PU BLICSEWER ® i !-00 'DRECEIPT NO DATE BY
HOUSESEWER CONNECTINGTO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLOO OR EPTIO RECORDED
WORK TD HOUSE SEWER 1 00
ALTERS P 1 E ISTINO NO I TE BY
SEWER OR DISPOSAL SYSTEM IDG
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
PETS AND/OR PTID GRAINFIELD"kPAUE PIT R 200 TION 3 7L ¢ f DEPTH /a
C P L-DRYWELL
SPECIAL CONDITIONS ONLY 200 0 MANHOLEREFEREMCE
1-6 UPPER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 00 CURB P L ML TOP L
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF_ 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ___ _ W__ _ __ BUILDING OR WORK
ADDRESS _ _ _ ___ _ _ _ _ _ _ SEPTIC TANK BEEP PITS)
AND ORDRAiMFI ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL[] DRYWELL '
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AMD/OR LICENSED AS REQUIRED BY LOB AM ELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I E LEGAL OWN- ABANDON HOUSE SEWER
EB OF THE ABOVE DESCRIBED REBID P ERTYBACKFILL SEPTIC nNK
SIGNATURE SEEP PIT(S)E] CESSPOO n0
OF PERNITTEE
TDAeuA OU 7/56 �►�/