Loading...
HomeMy WebLinkAbout1121A I I f . . , . , , �, 76A6d2D � J . . � ,� � •. . •.,.� . � � `Ee°8`RE�.°„8: APPLICATION FOR PERMIT: . �, �, ;:� j _ _ . .._ ..__.. .. .._SEWER - SEWAGE DISPOSAL � COUNTY OF LOS ANGELES ��UILDING AND SAFETY ' -' ''' '� � � i I FOR APPUCANT TO FILL IN oisrn�cr wo. c ► - ,; r�r � ; rnoc�sseo ev eK ;'Pc , . ; su��oiNo � �' �Q �j �� ' I wnoeeas �J �i� Jr r � �o���Y 7'� ONNECTION DATA:�' � NEAREST , STATION ^ ^ ''DEPfN � � ' � '� CIiOS3 8T. � PP MANNOLE REFERENCE j OWNl11 � . L !R � '� TVrE Of GONNlCTIO '•• LEN6TM PROM'" •� �•� � � � MAIL V. CUR! P.L. M.L.TO P,L. i ADDRESS � � ' ��� . � P.C.Hq. � � � / CO.IMP.NO.. • - .•"JOB NO. ' CITY � �� TEL.NO. l � � LEGAL TqUNI(PERMIT NO. ROAD PERMIT NO. DEEGNIPTION LOT NO. � AARIDAVIT WAIVER EASEMENT REGORD,INSTR.NO. OATE lLOCK TRACT � : NO.OF BL068. SIZE OR LOT NOW ON LOT MWV.OR ST.WIDENING IUSH OF BUILDINO3 STATE ENCROACMMlN7 ' PEFiM1T NO. I � INDUSTRIAL i CONTRACTOR � WASTE A/PROVAL t / � ADORCSS � � CHANGES CITV J TEL NO. GONNECTION CMARGE FEE �'�. STATE / .. % •• LIC: �) REIMOURS6MENT iE! . � f LICEN9!NO. CLA35 �r O NO. DESCRI TION OF WORK Pce . APPROVALS OATE t CTO � 316NATURE (� ' PUBUG SEW[RCONNlCTING TO �O , O '• ��• SEPTIC TANK.SEEPA66 PR OR� ��. NEW MOUSE BE W6R � � PRS AND/OR ORAINFIELD , HOUSE SEWBR CONNlCTIN4 TO CONN[CT ADDfTIONAL ' � PRIVATC DISrO3AL8VSTlM OUILDIN6 OR WORK CONNlCT ADOITIONAL OLD6.OR SEPTIC TANK,9!!r,r1T1S1 � �� .__.. ,... . .,._. AND/ORORAINPIlLD . .. _.. .. ...... ...,......._ . ...'. .. . � ........� WORK TO NOU3!SlWER .... ...... ... OVERFLOW SEBPA08 PR,DRAINPI6LD GlSSrOOL DRYWELL lXTN..G!$SPOOL.ORYWlLL.MANNOLE � � � ALTER.REPAIRORABANDONMOUSE � ALTER.R[PAIN,SlWENOR SBWER OR D13POSAL 3YSTlM SEWAGE DISVOBAL SVS�EM � • _.. . , . ...... ,..... � .. _.. ...... ......... .. _ .. .. .. . . . � D13CONNECT PLUO AND .. '.._ .. ... ... .. . . . .... _.... ... _.... �I ABANDON MOU9E fEWER '� ' ... B4CKFILL36PTIGTANK80... ..... . ,._. .. .. . .. .. .. ...... .... .. ... OWNER S Permit s �� SELP,rIT�91❑ cessPoo�s O . I AUTHORIZATION TOTAL FEE -• �J - . .VALIDATION = . - . � .,, - i . :, . I NAVE AT TM13 DATE A GCNTRACT WITN TN!NlR6W NAMlD CON. . ... .. ........ .. ....... .. . ....._...._...._.. . . ,.__.'_... .._.. . . ._ TpAGTOR TO CONN! T !ABOV!OlSGRIBlD lXISTINO OWELLIN6 i TO TME PUBLIC EE . t f ' 1 � I t.1 � ��'. �� BIONHDTMI3 ` � ' DAY OF..., ..._.....�p . .,... .,.._.,,._. .,.... ..,. _...._._............. ..,..._.._...._...__....... ... _.... .. OWIYER OR � OWNERB AGENT � • m �s D : �., � . ..... . .... , . . . .. . .. . ...... . ......_. .... ADDR68S ..._ ,r , . . � .... �' i:' � Z,'.�','��i ;, ' __..•.__._ . _._.._ __._... ....._. . ..._..._....""_"......�....._.,.......__..... .....� ��I NCRlEY AGKNOWLlDOE TNAT 1 NAV!RlAO TMt3 ArPUGA710N AND 3TAT!TMAT TM8 AEOVE IS CORRlGT ANO AORlC TO COMPLY c •+ n �t ;� W1TM ALl COUNTY OqDINANGES AND STATE LAW9 RlOUTATING " ` ` rLUM01NGANDSlWERS. .... ... , . .. . , .. . ... . ..... ... ....,.. _ . .. ..........._. .. . . . ....... .._._._—' I M!AlBY ClRTIFY THAT I AM PROPERLY RlGI3T[R!O AND/OR � � ''� C'—'� ��', LICENSEO AS RlOUIRED OV LQS ANGELES COUNTY AND STATE OF � � � � C4LIFORNIA OR TMAT I AM THE LEGAL OWN[R OF.AND INTlND TO RE•, .._. _ .., , „ ...„ ,..___,. . _ ., , ,_.. ,_ _ , . „ _ _ SIO!IN,TME ABOVt DESGNIOCD RlSID[NTUI ROPERTY. �� SIGNATURE � � � . .... ... . . ... . . . .. . . .. _. .... ,. .... _...... ........., . . ..._... , ,. ..... ..... .. _ ... ......, OR PERMfTT[E ' � � .. . . . . . , , _. .. . . _ .. . .. .._._.. ... � .....__..... . .. . . .r .... ,..... ... ._..__....._...... .... . . .... . .. ... . ....... ... .. .... ._..... __. ...._..... . . .... . , i � , . . . _ _ . . . _ _... _.�._ , . . .\ , . ( ` FOR DEPARTMENT USE � . , , � , � . � . �� F .�. � � � �'� REQUIRED INFORMATiON: . � ` ' ,�� .`,`' `` , ' � ' {' �i . . . .. - � ' , . ,. , .�. . ... ...�'. . 1. INDICATE ALL BUILDII�(GS,ON;PROPERTY:', .. , , ��'':� `!�'i','�•��� . , _ .. . .. , .. , 2. INDICATE AND'DIMENSION SE • WAG� DISPOSAL . . .. .. �;', ,,. �,: :,,... ��;� , ., � SYSTEM WITH'TIEIDISTANCES 'TO {BUILDINGS - - -•• � -' i� - r � , ; - AND_PROPERTYUNES... � `_ ._ '. �'....`.� . :--.. . . �,: ,1��:,�1 �`�' � ��-��� `' .i`.,��� ' .. � - ;. :_. � , ' .. :, r. . '.,; �, ,'---. '•� ' ..`. � ' . : �-.�� "� ` S; ..; \ , , . , 3.INDICA7E SIZE OF,SEPTIC.TANK•DEPTH OF SEEP�, , . .. -- --- - -�, �-. ---- f\ , ., • ._� . . � AGEPITISI-SIZEOFCESSP,OOUSI," . �,._. ._ .�.�; ,;' _;;.,.. ..�,,t ..�, ,� • � 4. INDICATE NORTH�D�RECTION�ON PLOT -� � .•-`"����1�.'-�•r.��\'� . �. '�_�)�,��. '� -!S�-'��.J� � I . �"� , : , , , \ , : � 1 ._._ .: � '...!..._--.. �.�_ . .. _ .. �.._...� �.����, � � q , '� �..''• ' J �~�i_ �Ij_.�t1,�� :. --' 5. INDICA7E BOTH STREETS IFCORNER. '•- -' -' • _....._�`- � _ .. , : ,,, ,�. _ . . . . . ._.. ..-----_.. . � � � '� l' � '-� � � ;.;C;1,,�\j\ - . - " `---- - --•- � , ,�,�- ,; .,,,. _ , , . , , - , '� , � � ---- ._ _.: ._...- --- � _ _ _ ' - \ . __... .. .- - -• - \ . . . ---•- �- _ .. hr. � .." •.i .r,:.� . . . .�.� . .CI', , , '' \`_. \ ���� �, I.. , '�i �. I � • � . � � .......... � .'��. ` �, l�... ._�_H.,... '. � . . t . • . "'_ . . ..... ..,. . .. . , ....__...._.. .._.._.. .._......... .. "_"._._........ ...... __.._ _ . '__" "' ". ;�., � I .. , . �'.. � "__'_'•. ... ...._.._.. . ._._. ... F ,-•.. .�.. ,� ..�;. . . � .`.�.,. �.` 'I'.;f ',CI.- l '. . ... . . .._�.... . .... . ..... ._� _ __ _ ..._' "'_'_'__'_�_...�_�'"_....__..._.. . .. ......... ... .. . :.. . .' . . ' ) ! _. .-- „ ----- ,` •-._ I' , '%; i S l�.!,1 � _.: ,.. ! 1 l `_ � (� ' i _ _. _..._ . , . ,_ •, , �� , _. 1 _ _ . ' .. :. 1 :� . , l\, J (.J l`C) � ��` .. ._ .._...__ ' ". . . . ... .__., ..._. .... .,7 .. �J.. � • � _ .. '. � .' : . ,.. •,.... ,a, i.. r . .. ._ (�� , . _ � n `1 � '�' : 1 ) \:... , �,��\ 1 �+ ___ . ..._...>�. 1`l.1`,� l ,��`. _ . , _._.. , _...''' __'"'.�.... _. .._ ... , . . . . . _. , . .. ' .._ . .. . ___. . .. . .. . . _.__ ..:t� ,''..�� ._ _ . . ._.__. �,f'�����.� t,' �'. ' .:. _ . ,. ' �� ,, .. , ,. , , ; � . . ,... , - . , . .: , ,. . - -�-- ----- - - ... . . . .. .. ,� . _ . --.. . ':' . . ,��� � � ,.. ,. . �� ; !. , , . . , r , . „,�.., . .. . . . ...._ _._. .. .. _ _ ; , ; . ... -- _.. ... . . . _ .. . ... . . _.. . _ � , ,, < ,. .,, . .. �. . , ,. �,, ._ __ _. .. . . . . , r , , , ST ALLEY'R/W -� , , _ ... _. _.._ ._.. , _, _ . _ � � • , _ _. ' ; , , ..._ - -•----.. _.. . _ , . � ,. . } .. .i �. :�.�I , �L. �— . . .. _. . _ ...... .. _ . _ .. . _'� __' , , I � .... ........ ... . ... . .. ....:�r,..: ' , , . . . ., , . ��. ;; ' .. I _., .� . , . . . . , I , , ,• . � I -�. �,: 1 ' •: � , ;� . _. . . ... _... _. _. __.. . . . . ,. ., . �, ._.. .._ .. ._ ._ , _ .. . _ .. _._ , � . ! _ ., .. . - - - ...._.. .. ._._....,-- ....... .. . . ._. . . —_ . . .,. .._.__ _. . . _�. ... :: , , . , ? . ,. , � � . . . i t.., . .� t:� FIELD NOTES ' -- .,.. . . _ .. '. � ,, .. . . .. . ' �, . „�;;: . __ _ . ;„� 1`.(. . r .;�,.` . ... � _ ` � ` ` , , . � .�,�-,1�, t �_•) �\. � J . _,,. . ., � �.. . ` , ,.1�.,� ,j...,�r _ � �., i . � , . . �.. � ,� „in • ; .. , ..;i . . • a �-. � , ., � � :. ^ ' � . �. ' f�. , . ' i . .)J � :.I'.� '� ' � �� � i �. . �� . . ... i.., .�/;. _� r . . �i� � , . . . . . •. . .11 l .�\ �,�l _��.. , i�1� � - :1.'. .. , ! ""' � I � I