HomeMy Public PortalAbout9817 VAL ST_Sewer__ DFrASTeEWvT OF COUNTY EN(EINEISB SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUUMING AND SAFETY PERMIT APPLICATION
COUNTY OF U)S AN0ELF8
WILLIAM J. FOX. MuNTY CNDINEER BUILDINGODRESS CIS f,
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ADDR[SS �J CROSS 3 G h P S r
LOCALITY
D7CT NO Rudy for I�rPeo0•n PERMIT NO
NEAREST 134 :386's
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CEI BY ISSUED BY DATE
OWNER _ e^ J
ADDRESS USE 0 PAMCY BK MAP PO
CI I L
CONTRACTOR Do IMI No. / -33 7.
ADDRERP T JOB.NO
CI EL MO TRUNK PERMIT NO.
Ir REGISTRATION NO / TATE
COUNTY ROAD PERMIT KO
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT NO / p / 1 PERMIT NO
BLOCK TRACT VO ad/ /(.•✓ INDUSTRIAL
WASTE APPROVAL
S12E OF LOT• KO OF OLDeS / CHARGES
NOW ON LOT
USE
BUILDINGS CONMEC CHARGE FEE
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NO DESCRIPTION OF WORK FE[
HOUSE SEWER CONNEC IKB 0 REIMBURSEMENT FE
PUBLICBEWER O S 330 RECEIPT NO BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
ftMNECT ADDITIONAL BLDG ORCEPITION RECORDED
WORK TO HOUSE SEWER 100 MO
ALYERORREPITIR FISTI NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
_ AMD/OR DISPOSAL SYSTEM loo CONNECTION DATA
SEPTIC
NTANK EEPAG[PIT ON D
_ PITS AN OR ORA NFIELD L.00 STATION T .7 DEPTH
CESSPOOL—DRYWELL J FEpENCE
SPECIAL CONDITIONS ONLY 200
• UPPE �b071lJER
_ '(YP�OFCONNECTIO LEMCTM FROM /
OWNERS PERMIT : I Y E/ CURB P L ML TO P L JQ
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS 9-SP CTO ITS SIGN TURF DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS 19_ MEWHOUSESEWER
OWNER OR CONNECT A KAL /
OWNfiRB A8E1 BUILDING OR
WORK /
SEPTIC TANK BEE/ IT(e/
ADDRESS__—_..— ANO/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL DBYW[LL
CATION AND STATE THAT THE ABOVE 16 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOIIAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY NEGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AB REOUIflEO BY LO6 ANGELES COUNTY DON NOUBE IS
ER
AND STATE OF CALIF IA OR TH Y T E LEGAL OW
ER Of THE ABOVE B MTI GOPERT' ACKFIL SEPTIC TANK
SIGNATURE SEEP PITIgo CESSPOOL
OF PERNITTE
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