HomeMy Public PortalAbout9811 VAL ST_Sewer__ DEPASTAKEMM OF OOUNPY ENCMNWM SEWER-SEWAGE DISPOSAL 1
DMSION OF BUELDMG AND SAFETY PERMIT APPLICATION
OOIINTY OF LOS ANOFI. .FB BUILDING �0
WILLIAM J. FOX. COUNTY E:MDINL m I ADDRESS
FOR}eppPV TO LL IN LOCALITYOU O`1
ADDRESS
�7 [// Iz
CROSS ST
/J
AODREBf /GOO/// �� ��
DISTP Mpq Rmdyforlm dl.. PERMIT NO
EAREST
LOCALITY �Gti�� 'r ',w c
CROSS BT J ✓ TV J
CEI ED BY DATE ED BY A DATE
EG
OWNER �
PAIL U ZONE OCCUPA Y BK MAP►G
ADDRESS
OITY �� TEL YO p d -coo
CONTRACTOR ` OO IMP NO
ADDRESSr2,4 �4I�Z,l/��- ���c'j JOB NO
CITY /_",C:3, '/%f�O TRUNK PERMIRMO
G. 1�STATE /
REGISTRATION NO ❑ COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOTH STATETNCROACHMENTPERMI \ /
BLOCK TRACT INDUSTRIAL \
WASTE APPROVAL
812E OF LOT _� NO OF BLOT
NOW ON LOT I CHARGES
USE OF
BUILDINGS p/•J/��'�J��J CONNECTION CHANGE FEE
NO DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO i REIMBURSEMENT FEE
PUBLIC SEWER @ $ Sb0 RECEIPT NO DATE BY
HOUSES EWER N TINGTO / \
_ PRIVATE DISPOSAL SYSTEM 100
COMM C ADDITIONAL B D B EXCEPTION RECORDED
WORK TO HOUSE SEWER 100
ALTER OR RE►AIREXI8 1T 11� no/I,' OAT[ \
SEWER OR DISPOSAL SYSTEM I DO
DISCONNECT AND ABANDON SEWER
_ AMD OR018POULOY8TE■ 1.00 CONNECTION DATA
6EPT TANK SEEPAGE PITO
_ PITS AND OR GRAINFIELD 2.00 STATION DEPTH
SPECIAL CONDITIONCESSPOOL-DRYWELS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
TYP F CONNECTION LENGTH FROM
OWNERS PERMR $ 1 00 r CURB P L M L TO P L
AUTHORIZATIONTOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUSL10 SEWER APPROVALS INBPECTON'S SIGNATURE DAT[
SIGNED THIS-DAY OF 19_ NEW HOUSE SEWER
OWNER OR //// Z� BUILDING OR WORK
OWNERS ASEIR .0`t
ADDRESS _ - SEPTIOTANK SEEP PIS)
Al
Ofl ONAIYFISLDT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL O
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
AND%OR LICENSED IAEREY ASS REQUIRTHAT ED BY PROPERLY
ANGELES ICOUNTYI DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT LAM THE LEGAL OWN-I ABANDON HOUSE SEWER
Efl OF THE ABOVE DWRIBED RE IA PROPERTY _ BA PTICTAN rI'"lI
SIGNATURE // SEE►PIT(8)E] OESSPOOL-6
OF PERNITTE .1�L
76AS42D BAR 462 2/54 ��
Z1)07- DEPAUTMENT OF OOUNTY ENGM3M SEWER-SEWAGE DISPOSAL 1
DIVISION OF BU L.DING AND SAFETY PE M TlIgjL ATION
OOUNTY OF LOS ANOELEB
WILLIAM J. FOX. COUNTY ENGINEER BUILDI
ADDR
ST
FOR APPLICANTT IN ` LOCALANOU I'Dj /���C?oi�Uil�J% CROSS CeLOCALITY G � DISTSERIAL MO PERMIT NO
CERD88 ST isa�s s
RECEdy hr I"pection DA E 188 D
OWNER 1s3
MAIL
AODRE88 /��'L l USEZON OCCUPANCY BJ
CITY TEL NO / ��� GK 70
CONT TaR ,Z; Co.Imp NO ,3 Z _,3
ADDRESS
' J08 KO
T L NO Q,, _
e TRUNK PERMIT MO
AT
REGISTRATION NO O.siO COUNTY / 7
ROAD PERMIT NO O
LEGAL 3
DESCRIPTION LOT NO STATE ENCROACHMENTPERMIT NO
BLOCK TRACT Z ,3� INDUSTRIAL
NO OF BLDGS WASTE APPROVAL
SIZE OF LOT 4 2�,5 MOW ON LOT Z CHARGES
USE OF 6
BUILDINGS /1 CONNECTION CHARGE F
NO DESCRIPTION OF WORK F5t /
HOUSE SEWER CONNECTING TO /G REIMBURSEMENT FEE
LI
PUBCBEWER ® [ S.[0 �f RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
WORK TO HOUSE DDITIOSEWERBLDG 0R 100 ,61 E% PTI NR[CORD[D
ALTER8R REPAIR EXISTING MO DATE 8Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AMD ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
PTO TANK,SEEPAGEPIT OR
PITS AND OR GRAINFIELD 200 STATION 1174 44
0 0 LrDRYWELL Q, O OfiPTN
BPEOIAL OOMDIT10M80YLY 200 L} ANNOL,EIIRflEFEpEMCE 0 LOWER
2,9
TYPE OF ECTIOM LEND FROM D
OWNERS PERMIT = I DO ML P L
AUTHORIZATION TOTAL FEE �I01!f jcr�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED) -
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGMA DATE
DWELLING TO THE PJBLIC SEWER
SIGNED THIS_L /�' DAY OF19 NEW HOUSE SEWER d r- 3'
OWNER OR //'L� CONNECT ADDITIONAL
OWNERS ASE/!�' BUILDING OR WORK
ADORESS GLS¢� —_ �.r _ SEPTIC TANK SEEP.PIT(S) _
AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[3 DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIp,SEW ER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
ANO STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWM
ER OF THE Affo J^EBCRIBED RESIDENTIAL PROPERTY RACKFILL SEPTIC TANKS
81GNATUgE �S� ^/ LpAj 'p BEEP PIT(S)� CE86POOL� SC �Q�.j
OP►ERtlITT[E L� /Ar`v
T""2D 063 I/N