HomeMy Public PortalAbout9849 VAL ST_Sewer__ nEranTnffivT OF.COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND .SAFETY PERMIT APPLICATION
COUNTY OF 1,08 AN(EIZS `
WILLIAM J. FOX, COUNTY ENGINEER .I BUILDING ADDRESSy7••�A �O IFi
FOR APPLICANT TO 'FI IN LOCALITY
BUILDING .� NEAREST-.
ADDRESS. �6` _ - CROSS ST.
LOCALITY
DISTRICTNO.'.'.. %SERIAL NO.. PERMIT N0.
NEAREST / / � �`� 0 A, �j/ s
CROSS ST. 'RECEIVED BY Ready tor'Inspeotlon DATE ISSUED
OWNER ` .( JI.ilnitDY.nw..
MAIL
ADDRESS � USE 2®NE OCCUPANCY BK MAP
' PG
f� i
CITY TEL.NO., �y
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06NTRACTOR (�`,( ,,� �� r ;
/ S CO.IMP.N0.
ADDRESS ��r L! JOB.NO.
CITY • '/./.✓+, JJP --' TEL.NO.07 Z /:2/2- TRUNK PERMIT NO.
REGISTRATION N0. � � /J' / `1�.. ® COUNTY' ROAD PERMIT NO. ,2•
LEGAL
DESCRIPTION LOT NO. _ STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT = WASTE APPROVAL b
SIZE OF LOT 6' NO.OF BLDG8. -
„ NOW ON LOT.• i CHARGES
USE OF �
BUILDINGS' p ,fi..�e;7' '�, w Q,rJ&E:?'p CONNECTION RGE FEE _
NO. DESCRIPTION OF W,ORIG FEE- Er`f
HOUSE SEWER CONNECTING40 REIMBURSEMENT FEE
PUBLIC SEWER V a $ 3.50 = RECEIPT NO. D E I B1f
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM . 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER-OR REPAIR EXISTING N0. I DATE I BY
SEWER OR DISPOSAL SYSTEM .1.00
AND/ORNDISPOSAL SYSTEM SEWER ',_ 1,00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ' - 2.00 STATION �' ='7� 'g7 - DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 • ,etNII7 PER ERENCE cgbOWTR
Y. WPE OF DONEE 17 M.L.TO FROM _O v/
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEES S`•�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR T0. CONNECT THE,ABOVE DESCRIBED EXISTING- APPROVALS INSPECTOR'PSIGNATURE DATE
DWELLING TO THE'PUBLIC SEWER
NEW HOUSE SEWER
' �SIGNED THIS- 99. _DAY OF:._� ' 19
j CONNECT ADDITIONAL
OWNERS AGWHER ENT.:d..i!L1!t� ., .. ��Ur» _. BUILDING OR WORK
ADDRESS..._..!... �F_.� ,el _.._t ._.�.^.._..___..._�_. J AND/OR DRAINFIELD IT(S)
1 HEREBY ACKNOWLEDGE-THAT 1 HAVE READ THIS APPLI-" CESSPOOL[j' DRYWELL�
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
I HERSEBY CERTIFY THAT 1 AM PROPERLY. REGISTERED DISCONNECT PLUG AND
AND/OR•LICENSED AS REQUIRED BY LOS ANGELES COUNTY" ABANDON MOUSE SEWER
AND TATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-'
'ER OF T E ABOVE D SCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
_ ' SEEP.PIT(S)[] CESSPOOLS
SIONATUREE�� /f�-f� X:4 � N�jfd. �-��1, 5 '/0"4�
OF PERMITTE _...... -L 11 ., +c.ar'tsLc.,:. :. (Z
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