HomeMy Public PortalAbout9860 VAL ST_Sewer__ DEPA.RT31ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS C2Pe6d
FO Ll ANT O FILL I LOCALITY , G
ADDRBUILDESSNG NEAREST
CROSS ST.
LOCALITY ` S DISTRICT NO. SERIAL NO. ^PPERMIT N/0. c
NEAREST '� y -• .�J A 23 —76"*/`�
CROSS ST. � r—�y
RECEIVED-B Ready for InsDectiod DATEISSUED
OWNER
MAIL
ADDRESS t`" C� USE ZON OCCUPANCY MAP
BK PG
] a
CITY TEV"NO.
CONTRACTOR -+ CO.IMP.NO.
ADDRESS ���� �y�,.� SOB NO.
CITYTEL.N�O�.] TRUNK PERMIT NO.
STATE
REGISTRATION NO. v�� 3 D (3' ® COUNTY ROAD PERMIT N0.
LEGAL �� STATE.ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT �Z 3 6(� INDUSTRIAL
;y WASTE APPROVAL
SIZE OF LOT ���Q /��j NOW ON LOTS • CH GES
USE
(/i✓�ve�-L "cl CONNECTION CHAR FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIOSEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTI RECORDED
WORK TO HOUSE SEWER 1.00
ALTER ORREPAIR EXISTING NO, I TE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT-AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEE
E PI
PITS AND/ DRA PANFGELD T OR 2.00 -/ c7
CESSPOOL—DRYWELL STATION TQ G DEPTH
SPECIAL CONDITIONS ONLY 2.003-3 / / ANNHHO�LE EFERENCE LO R
TYPE OCTION LENGTH FROM �y
OWNERS PERMIT $ 1 00 cuR6 lWaP.- M.L.TO P.L.
AUTHORIZATION I TOTAL FEE !j. '_
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THIS-2-6—MAY
PUBLIC SEWER
SIGNED THIS-2-6—MAYAY OF......._. %�/�-__Igo- NEW HOUSE SEWER AYd C
OWNER OR / CONNECT ADDITIONAL
OWNERS AGENT. . �., BUILDING OR WORK
ADDRESS................ AND%OR DRAINF IE PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
T0.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 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 RY.SIDENTI L PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE. _Gill
........_.......__ ......_.._._.---
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