HomeMy WebLinkAbout0 (13) 642D 2/70 PERMIT ,FO.�-(SEWER
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COUNTY OF LOS ANGELES SEWAGEDISPOSAL I�p
DEPARTMENT OF COUNTY ENGINEER h
BUILDING AND SAFETY DIVISION uILOINGi'...,i ;,\�!,` �.;t
JOHN A.LAMSIE.COUNTY ENGINKIER IA...... r...a<� .J:r -- ✓
COLEMAN W.JENKINS.SU►'T.OF BUILDING J_�;
LOCALITY
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OR' PPLICANT TO FILL IN NEAREsS ~
,PRINT OR TYPE ONLY) CROs6 T.
DESCRIPTION LOT NO.
MAIL 1
TRACT ADDRESS i
NO.OP BLDOY.
F LOT - NOW ON LOT CITY T[l.DISTRICT NO. GROUP C1A59 Ap PROCfSBEDSY
NGSSK PsACTOR IBB s t C.C] "1'L- i''iiL P CONNECTION DATA•~..1�.\'tiL�\14 �1 STATION � OEPTN
n� ,2ifC118 +/A-% MANHOLE REFERENCE UPP{R
E NO, ��DESCRIPTION OF WORK FCC TYPE OF CONNECTION y LENGTH FROMOUSE 51WER CONNECTING TO Y. CUR[ P.L. M.L.TO P.L.UBLIC f[WER ® .5.00 EPTIC TANK.SEEPAGE PIT 011 P.C.NO. III
PIT.ANO/OR DRAINFIELO tE .1000 CO.IMP,NO. JOE NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.� / • {
VATE DI.POSAL SYSTEM O [3.00 / / D_
CONNECTADDITIONAL SLOG.OR AFFIDAVIT RMvv •f lRvx RECORD.INSTR,NO, DATE O ,9Ip
WORK TO MOUSE SEWER 0 f3.00 Vey
OVERFLOW BEEPA GE PIT.GRAINFIELD W
E-N..CEBBPOOL.DRYWELL.MANHOLE 0 BS OO
rAUTHORIZATION
IPAIR OR FlANDON MOUSE HWY.OR Sr.WIDENING W
ISPOSAL SYSTEM $300 -STATEENCROACHMENTPRM ITNO.
INDUSTRIALWASTE APPROVAL00 CHARGES OTOTAL FEE CONNECTION CHARGE FEEIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING BRAD CONDITIONS BELOW I
TO THE PUBLIC SEWER.
SIGNED THIS DAV OF 19—
OWNER OR THIS FORM WHEN PROPERLY MACHINE VALI-
OWNERS AGENT DATED BELOW IS A PERMIT TO DO THE WORK
ADOREss DESCRIBED. "
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Permittee is hereby authorised t0 install the Work f
AND STATE THAT THE ABOVE Is CORRECT AND AGREE TO COMPLY o��sh wn, in aCCOtdaRCe with provisions of Ordin- p
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING arca IVo.2269 and related Ordinances.
PLUMBING AND SEW ERs. i
IHEREBY CERTIFY THAT I AM PROPERLY•'REGISTEREO AND/OR This permit become.null and void if Work is not cam.
LICENSED Ae R[O UIRED BY LOS Ne LES XOEINTY AND .TATE OF menced Within 60 days from date of issuance,
CALIFORNIA OR THAT I AM THELE L OF.AND INTEND TO Or If work li suspended at any hms daring PESIDE IN. THf�fOVt DE(¢RI[ R[fl T/IA�L�PR�OP{RTY. con-
struction for a period of 126 day[.Or if any work is
sloe AvRb�Arrra�� `-� I 'c'YL'f°f r done on the said building or structure inviolation of
the Count Ordinances o tat laws overni
VALIDATION JACK R.ALLEN
.CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
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