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HomeMy Public PortalAbout9842 VAL ST_Sewer__ HDEPARTAI NT OF COUNTY ENGINEER SEWERw-SEWAGE ®95P®SIAL DIVISION OF BUILDING AND SAF$TY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING J: Q r WILLIAM FOX, COUNTY ENGINEER I ADDRESS t1~ S,7&:(-7&• I: FO APPLICANT TO FILL LOCALITY BUILDING / NEAREST / ADDRESS e-147 / CROSS ST: 6 LOCALITY DISTRICT 0. SERIAL NO. PERMIT NO. NEAREST A 31-:233 s CROSS ST. v ,��� /��' ECE ED- Ready for Inspection DA ISSUEb OWNERl.%���iff�/� "'��,�w`� y MAIL ' USE ZONE OCCUPANCYBK MAP pa . - ADDRESS CITY `?— / TEL.NO. j'�r�—v L CONTRACTOR CO.IMP.NO. / 3 3 2- ADORE ADORES ° dY JOB NO. CITY TEL.NO ® TRUNK.PERMIT NO. REGISTRATION NO. 3� COUNTY; ROADPERMITNO: .2 fD 7c) LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. BLOCK TRACT /� 0 INDUSTRIAL — WASTE APPROVAL SIDE OF LOT �' C OW ON LOT / CHARGES BUILDINGS CONNECTIHAROE FEE NO. DESCRIPTION OF WORK FEE f HOUSE SEWER CONNECTING TO REIMBURSEMENT FE J PUBLIC SEWER a $ 5.50 RECEIPT N0: I DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM .1.00 CONNECT ADDITIONAL BLDO..OR EXCEPTION RECORDED WOR1,TO HOUSE_SEWER 1.00 ALTER OR REPAIR EXISTING r NO I DATE I BY 'SEWER OR DISPOSAL SYSTEM .1.00 DISCONNECT.AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.60. r CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR . 0v ©PITS AND/OR DRAINFIELD 2.00 / . ft DEPTH, CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY L00 a/ g MANHO ER REFERENCE J l� TYPE OF CONNECTION LENGTH.FROM OWNERS PERMIT $ 1 00 , Y. CURB L, M..L.TO P.L. T7— AUTHORIZATION TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED, CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TOT PUBLIC SEW€R �. SIGNED TpIS -DAY OF.:.� _._ ..-1 NEW HOUSE SEWER .OWNER OR � OWNERS AGE _ _. rye BUNLDING OR WORK RK ADDRESS.._ .. .: .. [.y- i SEPTIC TANK,SEEP.PIT(S)__....._._.._.... ____ AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS.APPLI- CESSPOOL❑ DRYWELL 1] 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 1 HEREBY CERTIFY THAT IAM 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 REOSENTJ41, PROPSBACKFILL SEPT.-IC.TANKS� r SEEP:PIT(S)� CESSPOOLS SIGNATURE. � // �I _ _ .OF PERMITTEE.. �.._..�._...---•_----. 'I"sim: 6413 7/5s