HomeMy WebLinkAbout2939A6A642D CE 808A 9/77 APPLICATION PERMIT
SEWER ® SEWAGE
®®
DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY
ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN
DISTRICT NO. GROUP MAP PROCESSED BY
B�K9/ PG
BUILDING q 2O6 O ♦ ld�. d,lm�4i Llr. a
ADDRESS b
I
Diamond Bad.
CONNECTION DATA
LOCALITY
STATION .G� DEPTH
NEAREST
CROSS ST,
✓" / ��J
MANHOLEREFERENCE ,;'{ dG:-" ,._,,.UPP_E
� LOWER
e
OWNER • ��'°
TYPE OF CONNECTION LENGTH FROM
MAIL q 7731 Irvine Blvd.
ADDRESS (,J t✓
Y. CURB P.l. M.L. TO P.L.
.L (
Tustin `�'I ��y7 q4
�% 31 — 141
P.C. NO. €'"%F �.•^-
CO. IMP. NO. JOB NO.
CITY TEL. NO. (
LEGAL q
TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. J.
AFFIDAVIT WAIVER EASEMENT RECORD. INSTR. NO. DATE
BLOCK TRACT 31677
NO. OF BLDGS. R
SIZE OF LOT NOW ON LOT -L
HWY. OR ST. WIDENING
USE OF
BUILDINGS residence
STATE ENCROACHMENT
PERMIT NO.
55 �1- Q�
Rhoades Constr.Equip.
INDUSTRIAL
CONTRACTOR V✓o�+r ® �a+
WASTE APPROVAL
Box 1418
CHARGES
ADDRESS
CONNECTION CHARGE FEE
CITY Ontario TEL, NO.
STATEP� [
.REIMBURSEMENT FEE
LICENSE NO. 262369 CLASS
NO,
DESCRIPTION OF WORK FEE
APPROVALS
DATE
INSPECTOR'S SIGNATURE
HOUSE SEWER CONNECTING TO
@
PUBLIC SEWER
NEW HOUSE SEWER
SEPTIC TANK, SEEPAGE PIT OR @
PITS AND/OR DRAINFIELD
CONNECT ADDITIONAL
BUILDING OR WORK
HOUSE SEWER CONNECTING TO @
SEPTIC TANK, SEEP, PITISI
AND/OR DRAINFIELD
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG. OR @
WORK TO HOUSE SEWER
CESSPOOL ❑ DRYWELL ❑
OVERFLOW SEEPAGE PIT, DRAINFIELD
CO
EXTN., CESSPOOL, DRYWELL, MANHOLE
ALTER, REPAIR OR ABANDON HOUSE @
ALTER, REPAIR, SEWER OR
SEWER OR DISPOSAL SYSTEM
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BAC KFILL SEPTIC TANKS ❑ '
SEEP, PIT(SI ❑ CESSPOOLS ❑
OWNER'S Issuance Fee S !) 0
AUTHORIZATION . TOTAL FEE ' � 4,A
I HEREBY ACKNOWLEDGETHIS
AND STATE THAT THE ABOVE ISACORRECT ANDI HAVEDAGREE TOLICATION COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
PLUMBING AND SEWERS.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
TO THE PUBLIC SEWER.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RE-
SIGNED THIS DAY OF 9 _
SIGNED
IN, THE ABOVE DESCRIBED RESIDIAI PROPERTY.
OWNER OR
!
OWNERS AGENT
SIGNATURE `' !
�1f
ADDRESS
OF PERMIT_
VALIDATION
CK. M.O.
CASH