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HomeMy WebLinkAbout1119A _ . . . . .. . _.... , . . .. __ .. . . . . � .__.. 7anaa�o . ..... . , ,. ,. , .. , � '�, CE8081REV.6/IBi APPLICATION� FOR PERM[T_,.-..:. .. . . � . .: .. ms • . _ SEWER- SEWAGE DISPOSAL � � � .._. . ... ._.._. . ._ � COUNTY OF LOS ANGELES BUILDING AND'SAFETY -'.. ' IFOR APPLICANT TO FILL IN o�srn�cr No. ,c w �, .Mr,► � reocesseo er ew�.owa JG�,G � ' � , '� r�4 " �� ADDRCSS '' CONNECTION DATA �: LOCALITY • I. NEARlST STATION��� � - � � OCPTH' �� � � . GR039 ST. . .. . . . . • INANMOLE REilRlNCEO,� /L UPPER � � IOWNER � �� G • LOWBR � MAII fj 'YN�E Of CONNeCT10N LlN6TM/NOM��• ADDR664/( �� Y� CURO ,L M.LTO►.l. e �, �I��� . . _�P.G.NO. - V O( • . . .. GO.IM►.NO. '�"JOB NO. ,� GTY � TEL NO. �� ' LEOAL TRUNK rlRM�T NO. ROAO PERMIT NO. DESCRIPTION LOTNO. Q AFFIDAVIT WAIVER EASENENT qlCORD.IN3TR.NO. OAT! � lLOCK TRACT � t � NO.OR BLDOS. � SIZE OF L07 • NOW ON LOT NWY.Ofi 3T.WIDENING USE OF r BUILDINGS ' 3TATE lNGROAGNMlNT � �, PERMIT NO. J GONTRAGTOR �� INDVSMIAL WAST!.IPPROVAL I ADDRCBS, �� / � CNARGES � GONNEGTION CMARGE FEE CRY T!L NO. �" D I STATE � . LIC. �� /� REIMBUR3EMlNTrEE ' � I' LICENBE NO. Cugs �1 O � NO, DESCRIPTION OF WORK �EE �� APPROVALS DATB �PlCT ' 16NATURE V MOUSE SlWLR CONNECTING TO � ' ' PU9LIC S!W!R � � O -� BEPTIG TANK.SlEPAGH PR OR . NE W MOUSE S!WEN � , .. , ..._.._ _..... . rR!J1ND/Oq ORAINrIBLD C4NNEGT ADDITqNAI. �� HOUSB SEWER CONN6CTIN0 TO pU1LDIN6 OR WORK � PNtVAT!DISPOSAL SVSTEM � gEPTIG TANK.3lEP.PRISI CONNEGT ADOITI4NAL OIOG.OR .,_, MIDIOq CRAINFIlLD ....... � _ _ WORKTOMOUSlElWER . .. __..... ... ..�.. .... . . .. .., ... .... .. . ...,.... _...,. .. I OVERFLOW SLEPA08 PIT.DRAINPIlLO C[SSPOOL DRYWELL EXTN.,Cl33P00�DRYWELL.MANMOLE � � ' ALTlfI.RFPAIROR ABANDON MOUSE . ALTER.REPAIR,3lWCR OR SEWBR OR D14POSAL o�STlM SEWA6E D13►OSAL SVSTlM I. ,. �„ ._......... . ... ._ ....,__,. ....._ _.. . . . . . ...._. ___. . OISCONNECTiLVOAND .... ... ... . . .�_.. ...... .... ..... .� ADANDON NOUS!SCWlN � �. . . _ . .._ .. � .. .. . BACKFILL RlPTIC 7/WK3 Q.... ......._ ..... ..._...._. . ,. ... ' OWNER'S Permit s fElr.PITIEI Q GE43POOLS❑ ' -. .::.: ..... ..VALIDATION : . . AUTHORIZA710N TOfiAL FEE � .. . . ,. - .�. , ..: . 1 HAVE A7 TMI3 DATE A GONTRACT WYTl1 TM!NEREIN NAMFD GON� . _ .... . . . .__,._... ......_..__ _. .. ._ .. �,...____._ TRAGTOR TD CONNECT TME AlOV!DlSCRIBlD�ISTIN6 DWFLLING � . :..: 1 1 1 : f�� I� TOTM!PUSLIC 3C � il 31GNEDTMIS ..,. ...--DAYOF.. . . .. . ��v -. .--. ._. . .__,_. .. _..._. __. , .-.., ........._.1i o.�..� E_�..`, . ... i OWNCR ON /� _.,`� � '� I OWNlRSAOCNT 4�� � ' _ � .. .. .......... ... ............. .. .. . # '�.L,.(�.��._. . " _ , -..........., .,� r, . . ADORl33 ....,x � :. �� r , � �1 MCRlOY ACKNOWLlOG!TNAT I MAVt READ TMIS�APPUCATION' " '�'��"" � " � `" "�' �� " �" ' "�-"�' i �-� �� ���•����� - I� AND STAT!TN47 TN!AOOVE 13 GORRlCT AND AOREE TO COMPLV WRM AlL COUHTY ORD�NANC[t AND ETAYC LAW9 REpULATIN6 �,`S, �., � : PWMBINOANDSlWllt3. ................ .... _ .. . ..... .. . ... .... .. . ..._.'...._....... .. . . .._..._.. .. ...__ ..f� Ei,� 1.. .,....--.......... 1 MERlOV CERTIFY TMAT I AM PROPERLY RE613TERED AND/OR LICtN3ED AS RECUIRED BY LOS ANOELlB GOUIYrY AND lTAT!OR ��, CALIFORNIA OR TMAT 1 AM THE LF,6AL OWNlR OF.AND IMTlND TO p!• ... . . _ .. _. ,. .. .„..:.. ,.._. ._ . ..._._.... SIDE IN,THF ABOV!DESCRIBED RE810lHT PROPlRTY. � � � ♦ � SIONATURE .. _ . ._... ... . . _ . . _ . . ,.. ........,.._. ....'__........._...... . ._. __..._ .___......, _' '.. I OF pERM ITTEC ' . . ..... .. .. .. . .... ............_ �.. . ....... .......... ...__... . I _ "..... .."_..."'"'_._._..."""..__,..._.__ "."_...._ __.._..'__..__..__..___. __._ ._.__ _'_�_._...._"_�""""........ ....... ...._....... ._.... ..."'—,.._.,_.. .. L _._.. . _ _ . . � � FOR DEPARTMENT USE , c.� . "' T ;'� � � "�:.. r ,. � :. REQUIREOINFORMATION � ' ` ' ' ' '' � � f � R � . _. . ,.�, . , . ...� .�. l. INDICA7E ALL BUILDINGS QN 1PROPERTY..1;: i ', . . '.'. i ;'._ `. =i" C:::. 2. INDICATE 'AND DIMENSION`5EWAGE DISPOSAL �; �� (:; ,b;:.�� , , :+ ;. SYSTEM WITH'71E ;DISTANCES TO �BUILDINGS .. . \.. .,.— �� .� ...;,..--7= : � ��.,•.�ti, , ANO AROPERTY LINES.` . _,. ::, t.. `• .. .�- �.,.. �:.�:�,'�.'� .'... . �.;_ r , - . _ _ _ .._..��� a . ; ., , ,, , 3.INDICATE SIZE OF,SEPTI.C,7ANK-DEP,TH,OF,SEEP,•� � - - ----- -- - —���� r� `''3?�� 1 r',' �r AGEPITISI-SIZEOFCESSPOOLISI...__: ,.'..� - ........ .- .: . ...._ . �.'�-'��� � . •-1� ii.;., �� ;.,.,��_ '.. . �., ' , _ . . . . _ , . ,• . � � ;. ... �, ; - - . ...__. •�.:, '4 - , . . .. , .i �.�. . .. \�J� 1'`� �� �'J a. 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