HomeMy Public PortalAbout9740 VAL ST_Sewer__ - I Loa3
DF,PAxTDffiYT OF oovxxY ENGINEEB SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGET.F$
WILLIAM J. FOX, COUNTY ENGINCCR I BUILDING ADDRESS � 7
FOR APPLICANT _T^y F L IN LOCALITY G,
BUILDING 77//6
Ji( � L� /J/ NEAREST
ADDRESS //LJ ( !ll��� ���C CRO888T
LOCALITY DISTRICT NO SERIAL NO I
�1 `�P�ERRMIT NO
NEAREST _T A , �C/$ tS �Z6 s
CRO 888T- 'A dAr44z- RECEIVED BY R"dY Iw lnspwUeo DATEISSUED
OWNER �J' ,� (� —.2j--re/
ADDRESS �� C U8E 20NE OCCUPANCY BK MAP PO
CITY _ .�7 TEL NO _ O &G O fj S ,
CONTRACTOR ..-u _ CO IMP NO
ADDRESS JOB NO
CITY TELMO
�, G lf_7,p ITRUNK PERMIT NO
REGISTRATION NO / ��� l+ SBUNTY ROAD PERMIT NO
LEGAL STATE ENCROACHME
y PERMIT NO v
DESCRIPTION LO O
BLOCK / TRACT pry—,fie- INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF BLDG$ J) CHARGES
MOW ON LOT O'•�
age
USE OF
BUILDINGS CONNECTION CH EF
NO DESCRIPTION OF WORK FEE
HOUR SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ f L50 RECEIPT NO DAT BY
HOUSE BEWE CONNECTING TO
PRIVATE DISPOSAL SYSTEM I00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100
ALTER OP 1 EI M NO DATE BY
SEWER OR DISPOSAL SYSTEM too-
DISCONNECT
AMD OR DISPOSAL SYSTEMN SEWER 1 00 CONNECTION DATA
BEPTIO ARK SEEPAGE PIT OR / �/ /
PITS ANG OR GRAINFIELD 100 STATION �(p r1 . DEPTH
SPECIAL CONDITIONS ONLY 100
TYPE OF Comm E TI LENBTN OM /
OWNERS PERMIT $ 1 00 Y CURB P L M L TO P LFR
AUTHORIZATION I TOTAL FEE ,yD
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE AOOVIL DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER _
516NED THIJDAY OF 1�• NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL 1"
OWNERS AGENT _ _ BUILDINOORWORK
ADDRESS _ _ AMO IOR DRAT IFIELD IT(8)
I HEREBY ACKNOWLEDGE THAT I HAVE MEAD 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 SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY AC SEPTIC TANK �.��J. �/
SIGNATURE ,�11��� � SEEPPIT(S) CESSP00 6IZ6 or
OF PERMITTEE�/� �'-3. .�pbt.'_
76A813A Bill, 7/88