Loading...
HomeMy WebLinkAbout1116A f_. __._ . � . . ._ , �aAa�o � `� CEB08(REV.6/7811/79 APPLICATI4N FOR PERMIT : �s ! SEWER - SEWAGE DISPOSAL ; COUNTY OF LOS ANGELES BUILDING AND SAFETY � FOR APPIICANT TO FILL IN O�SiRICT NO. GPO P MAP PROCESSED BY � �� , PG BUILDING�J /] � � � ADDRESS.[�/!� � ` CONNECTION DATA kLOCALITY NEAREST . � '1 STATION � DEPTH � CRO55 57, � r 1 MANNOLEREFERENCE /��� L UP=ER OWNER J � �W TYPE OF CONNECTION LENGTM FROM �� MA�L � Y. CUF6 F.L. M.L.TOP.L. I ADORES OD/ � t � � �I � P.C.NO. � ✓ �V CITV'' TEL.NO. CO.IMP.NO. JOBIVO. LEGAL TRUNK PERMIT NO. ' ROAD PERMfT NO. DESCRIPTION LOT NO. �� �, AFFIDAVIT WAIVER EASEMENT RECORO.INSTR.NO. DATE � 6LOCK TRACT 3 0 6 � NO.OF BlOGS. , St2E OF LOT NOW ON LOT HWY.OR ST.WIDENING � USE OF � BUILD�NGS STATE ENCROACHMENT � PERMR NO. a INDUSTRIAL i CONTRACTOR WA57E APPROVAL � ADDRE55, �TS, L � GMANGES � � CITY TEL.NO. �J" Q �J "� CONNECTION CHARGE FEE �'� ISTATE 4 LIC. � /) pEIMBURSEMENTFEE � LIGENSE NO. CLA55 G '� ,(� � I � No. DESCRIPTION OF WORK FEE V HOUSE SEWER CONNfiCTING TO APPROVALS DATE INS E R'S SIGNATURE � PUBLIC SEWER � SEPTICTAIVK.SEEPAGE PIT OR � NEW HOUSE SEWER � � � PfTS ANO/OR DRAINPIELD CONNECT ADDRIONAL HOUSE SEWER CONNEGTING TO BUILDING OR WORK d PqIVATE DISPOSALSYSTEM {/� SEPTIC TANN.SEEP.PRIS) CONNECT ADOITIONAL BIDG.OR AhID/OR DFAINFIELD � y WORNTOHOUSESEWER � � OVEFlFLOW SEEPA6E PIT,DRAINFIELD ' E CESSPOOL ❑ DRYWELL❑ � � E%TN..GESSPOOI.DNVWELL.MANMOLE ALTER,REPAIR OR ABANOON HOUSE ALTER.REPA�R.SEWER OR SEWER OR DISPOSAL SVSTEM SEWAGE DISPOSAL SYSTEM j � ' � DISCONNECTPWGAND ' i ABANOON HOUSE SEWER ' i,, I � BACKFILlSEPTIC TANKS❑ � ( SEEP,p1TI5)❑ GESSPOOLS❑ � �WNER'S Permit s t7-Q 4 AUTHORI2ATION tOTAI FEE �� VALIDATION I MAVE AT THIS DATE A CONTRACT WITH TNE HEREIN NAMED CON- (� TRACTOR TO CONNHCT TNE ABOVE DESCRIBEC EXISTING OWELLING :._,� � �,E� r{ TO7HE PUBLIC SEW . � SIGNEDTHIS �AYOF 7� ' �! • '� '�,� � � OWNEROR � OWNERS AGENT �J • b ,1.800 ' ADDRE55 I HEREBY AGKNOWLEDGE THAT 1 NAVE pEAO TMIS APPLIGATION �O 'Q�� � C.�G C ANO STATE 7NAT THE A60VE IS GORRECT AND AGREE TO COMPLV � � � p WfTH ALL COUNTV ORDINANCES AND STATE LAWS REGULATING O� 1 C� C1� � . PLU M B ING AND SE W E R5. ►- 1 MEREBY GEi1TIFY THAT 1 AM PROPERLY REGISTERE� AND/OR '�. LICENSED AS REOUIRED BV LOS ANGELES COUNTY AND STATE OF ' ' �h GALIFORNIA OR TMAT 1 AM TNE LEGAL OWNER OF,ANO INTENOTO RE• � SIDE IN,THE ABOVE DESCRIBED RESIDENTIA�PqOPERTY. � � � � SIGNATURE �� OF PERMITTEE ' \. . _ -- - _ . ___... _. , i� , . ; FOR DEPARTMENT USE � �� I � REQlJ9RcD IiVFOnMATION � � 1. INDICATE ALL BUILDINGS ON PROPERTY. � i 2. INDICATE AND DIMENSfON SEWAGE DISPOSAL ' � SYSTEM WITH .71E DISTANCES TO BUILDINGS . . � • AND PROPERTY L1NES. ' � ' '�:.t_� ; .� � � ��.'•. _�::_.. ,, t.1���,'1:::' � �� ' � , , , � 4 3.INDICATE SIZE OF SEPTIC 7ANK-DEPTH.OF SEEP- �' '�`'`�' `'�" `� :� � AGE PIT(SI•SIZEOF.CESSPOOUSI. • � • ' � � -` `_�� .._,; :�.�� '> �'� • ' j ` ' � �. . . �-'�-� .\.. i � ';'r,� � 1. 4.INDICATE�NORTH DIRECTION ON PLOT. � - � -� �� ' � - � ' �,� j 5. INDICATE BOTH STREETS IF CORNER. '`\�)`'• ' '�- • - - ,� \ • �' �1�'J'��'�.�, � � l ,;� \-�'.��. C �,._..,'�. .._�, ., `., � � " ?. . �, . ...� , , . I . �� .�,�,i r; � ' , E ' t � I . ..l \C„a . � r.t__,j.` . . � � \".... �`�' .. _ 1'��. . �, � � . '�:.a� \�� - •��• '.`. .. , '� �:.�'\. . C. �J � `�+— '�,, ��,,- .j �r, �`i.'�6J � . -``,�' - `� �t:�`;. i'�;`, . i .. ... ; � , ; _ � , , ' ST,ALLEY R/W , � I ', � , I , , I FIELD NOTES � `. ` i ,,•. _ �,` '_ti:!.:,'.' t ;`• C , . _, 1, i � I 1 ' , � ` . . ,'..�1 , . . �.) �'• ` ,1O �l