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HomeMy WebLinkAbout1118A . ., . _ .. ... . _.. .. . �' , � � + 76A64�D ' CEBOB(REV.6/78)f/79 qppLfCAT10N FOR PERMIT ! �, I . SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGElES BUILDING AND SAFETY i ( FOR APPUCANT TO FILL IN OISTRICT NO. Gq/p��P MAP PROCESSEO BY � BUILDING� �fC �,!�f I' M �Pr � ADORESS V� � }'� ��' �� � . CONNKTION DATA LOCALITY ,��� NEAREST � STAiION DEPTH �yI � t • CROSSST. PPER ��„�� MANHOtE REFER£NCE a � y �{ LOWER � OWNER SY � TYPEOFCONIVEGTION LENGTNFROM - MAIL Y. CURB P.L M.LTOP.L AOOfiE55 / ` � �� P.C.NO. CO.IMP.NO. JO8 NO. CRY TEL.NO. LEGAL TRUNKPERMITNO. ROADPERMRNO. � DESGRIPTION LOTNO. Q� AFFIDAVR WAIVER EASEMENT RECORD.INSTp.NO. DATE IBLOCK TRACT NO.OF BLDGS. �512E OF LOT NOW ON LOT MWY.OF 5T.WIDENING USE OK '6UILDINGS STATE ENCROACHMENT PERMfT NO. �CONTRACTOR ' � INOUSTRIAI WASTE APPROVAL � / 'A�DRE55 CHAFGES '!CITY , TEL.NO. r O O CONNECTION GNARGE FEE � '�STATE � LIC. �/J/) REIMBUFSEMENTFEE d LIGENSE NO, CLA55 Y Lr Q �NO. DESCRIPTION OF WORK FEE APPROVALS OATE NSPE 'S NA RE V , HOUSE SEWER GONNECTING TO � ' PUBUC SEWEH ' � (�I' O � � SEPTICTANK.SEEPAGEPITOR NEWMOUSESEWEA ( y PITS AND/OR ORAINFIEL� CONNECT ADORIONAL Yl . MOUSE SEWER CONNEGTING TO BUILDING OR WORK �L PttIVATE DISPOSAL SYSTEM 1/1 CONNECTAO�ITIONALBI.OG.OR SEPTICTANK.SfiEP.P1T(51 '� � ' WONK TO HOUSE SE WER o.NO/OR ORAINFIEID .� � OVERFLOW S6EPAGE PIT,DRNINFIELD . iEXTN..CESSPOOI.DRYWELL,MANNOLE �ESSPOOL � DRYWHLL❑ + ALTER.REPAIRORABANDONHOUSE qLTER,REPAIR.SEWEROR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM � ' ' OISCONNECTPLUGANO ' � ABANOONHOUSESEWER �� BACKFILLSEPTICTANKS[] OWNER�.S Permit s h SEEP.PITf51� CESSVOOLS❑ �. { AUTHORIZATION TOTAL FEE / D VAUDATION � 1 MAVE AT TMIS DATE A CON�qACT WRN THE HEREIN NAMED CON- TRACTOR TO COHNECT THE ABOVE DESCRIBED E%ISTIN9 DritLLiNG TOTHE PU6LIC SEWH . ` � � 1 O 11 r� SIGNEOTNIS DAYOK 19� I �l r1 I OWNEROR #� •; • • 1 O OWNERS AGENT � � ADDRESS ' �� �n'! '1 II.O� � 1 HEAEBY ACKIVOWLEDGE THA7 1 HAVE READ THIS APPLICATION � AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY . � n•0 1 II.0(1� y WRH ALL GOUNTY ORDINANCES AND STATE LAWS REGULATING , , � PIUMBINGANDSEWERS. . / (� q (�� � � LICENSED AS REOU�RED~BY LOS AN ELESLCOU T'T ANO 5T TE/OF � O�3 � 7�`��J I CALIFOq1VIAORTMATIAMTH6LEGALOWNEROF,ANDINTENDTORE- . . SIDE IN.THE ABOVE DESCRIBED HESIDENTIALPROPERTY. , SIGNATURE , ' O F PERM fTTE E � 1 . � . . ----- -- - # . , FOR DEPARTMENT USE � 1 nEQu��ED t�For.r�n�Tiora . 1. INDICATE ALL BUlLDINGS ON PROPERTY. � � 2.INDICATE AND DIMENSION SEWAGE dISPOSAL � SYSTEM WITH 'TIE .DISTANCES TO BUILDINGS � • r- '.. • ,,� ��; i AND PROPERTY LINES. . . .. ' ,�� ' - -•=j -• �'�� `:: � �,.-. I I OF.SEPTIC TANK•DEPTH OF SEEP• � ���������' ,�\� 3.INDICATE S ZE . . �� . � E PITISI•SIZE OF CESSPOOLISI. : • '- ,..,,:; .i:: `� ...,. '_, 's�, J-`: ��i AG .. , . A.INDICATE NORiN DIRECTION ON PLOT. ' '','� � �-.''-�'k� ,�. � 'C• `' � �''�:;1)`,`' \ _ ... ���.` � � 5.WDiCATE BOTH STREE7S IF CORNER. ` \�'`'�" � '�\'` , �` ` � � ; ! ' `� t�-\t.�;l�: �.,1. �,r� S � ; �:.� i '�.�i�`_ ` . ��� .. t: l.' �' _ �.1_;r �:. ,�i: `, �,� 1• �r'�� . 4 � . . . . , ' �f-i� � ,I��ti, ti..J,.,. .� ., �k` �;C:�.�,'� �� . :_ '� i:'.. `.'.�`� . +, �, ,,�-��� !� _�_��,'-,.` \i :i �� �.� '`. , � , � ST.ALLEY R/W � 1 I i i . i i � + j FIELD NOTES . , � �•� � r �- � �� C, • • �� ���, :.\ ���.: � � .� . 'j_1\ •,�•�; r'1 �� , t i I '1 I � ! , �-- � . . � . , . I ' _ �. � '-` .- ' �i !�� �1 .:J .. .�- : h ` � �