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HomeMy WebLinkAbout1695A i7D �.�. . , .,., ._ . . � � IREV.6�781 APPLICATION��FOR PERMIT.�,,_ : ,.. , , �. , . _..__...___ .. . ,___ _ _SEWER -_SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING AND 5AFETY ' ' � �-���� • FOR APPLICA T TO FILL IN DISTRICTNO. " 6ROUP • � M�►'(` " _PROCESSE0,9Y" . . . BK. _ . �.� .. , . �. . �ciNa dj m� 'o� 3 .c��l�i . _, )RESS :A�m CONNECTION DATA �REST � STATION�. . �-'� ' DEPTH . .. . . � . . �SS 5T. ,/... UPP MANM �R E CE N � LO [R NER __ _ ._ . ._-.L _. _ _._.......... . .. .. .. _ .__ __.__ _ _ ... _TVPQ Of COMNECTION '.•-'1,ENOTH FR6M'-'... ..—.- ' )R[SS . Y� CURB P.L M.LTOP.L - P.C.NO.- , GO.IMP.NO. -� � �� JOB NO:- ' �� � TEL NO. LEOAL � TpUNKPERMITNO. ROADPERMRNO,._______._____.- --_---- CNIPTION LOTNO.-._ �------------.. . _.____'___. .___� _ ' ' AFFIOAVIT WAIYER E115EMENT RECORO.IN57p.N0, pATE :K TRACT � . -- . . . . . . � - NO.OF BLCGS. OF LO7 NOW ON lOT HWY.OR 5T.WICENING OR .DINGS - ST/1TH ENCROACHMENT P6qMrt Nq. ..�TRAGTOR IHDUSTRIAL . � W/1STE APiPOVAL AOORES � �.Q CMAfiGE3 CRV EL IVO. CONNECTION CHAR6E FEE BT�T� '� ��- R6IMBVRSEMEMTFEE ' � 4CENSE NO. CLASS � _ MO. DESC w►�►►oF wor+K - rE� � - �-� -- �- - APPQOVAIS DATE OR'S NATURE v NOUiE 58WER CONNlCTIN6 TO 0 � � � - Si1RCTANKLiEPA6fiP1TOR � --- - . NBWMOUSlSEWER � � (0'! ; /RZIiWDlOpDM�NFl[LO -._.. _ .. ' CONNECTADOtTqNAL � MOU�R Sf W6R CONNHCTIN6 TO 9UIlOIN6 OR WORK ; PRNAT!DiSPOSAL f►STFM SEPTIG TnNK.SEEP.PITl51 - � � i CONNEC7AOpR10NALBLOO.OR . _._ ..... .. ...._.... _. AIVO/ORORAINFIElO _. . _ _ __. _ '- , ri4RKT0 NOUSF StW6R. '.�._._. ti � OYEXfLOW SECPAGE PR,DRAINR�E�D GESSPOOL ❑ ORTWELI❑ EXTN.,GESSPOOL.DRYWELL MANNOLE I ALTER,REPA ROR ABANDON HOU6E � ALtER.t36PA1R.SEWiR OR � EffWERORDI$WSALSYSTFM SEWA6EDISPOSALSYSTEM � . . . .'.. .... . .. .... ..._. ..__ ._ .___.__. . . . . __. ._. � � DISCONNECTPLUG AND ' ' ..-..�.... '' -..,'-_�....."'_'""' _ .._.. � A9A.NDON MOUSE SEWEq • � BACKi1LLSEPTICiANKS❑ - . � ._._. ' OWNER'S Permit a � setv.vms�Q�EssPoo�� - _ �.--1 6 9... f, � AtlTH61tIZAT10N TOTAL FEE _. _ - _�_..._� -. . ._::_YAUDATION- 3; � � y • 1 C. „ . p: . . : TRACTOR TO CONNt T TNE BOVE FSCFIBED~Ez�ISTIH6 DWELL N4 �� '. ..._.�-� .. •.�..- .�.�.�_. ....��'.. ..� . � � • � CP.O C�...� .-._ TOTHHPUBIIGSHWER. . . . _ . ._... . ._'_...____._ .. . ..__._. .... .----.� 4 u ,. Y ` SIQNHDTMI9�'DAT OF- .. •��.. . is�,y . 1 F C�;.G�_..._.� .� ��. OWNERSAGt --�� _ .. . . _ . .._.. _ _ _--- -_.. C.7.C.�-8(1- -_..... ADDRE54 �) ' �1 MERl9Y AGI[NOYVLlOGH TNAT�M6VF READTMIS APPLICATION _..__..._ . _ _ .. . . .. . _""_"`_'_'___._�.._"'___"'_.,_'_'_'_•..._ AND STATH TMAT TM8 ABOVE IS GORREGT AND AGREE TO COMPLY WTN A11 G4UNTY OROINANClS AND 3TATE LAWS REGUTATING PLUM91M6 AND SEW[AS.. . . . .. . -.. .. .......... . .... ..... . _....._ .._ . ._,__.....__. .____ ..... ._ _.____._. I HEREBY GBRfIfY YNAY I AM rROPE1tLY REGISTfiRED ANO/OR - LIC6NSED AS REOUIRlD SY LOS AHQELES GOUNTI'AND STIITE OF � CALIPOFNM OR THAT 1 AM TME LE4AL OWNER Of.AND INTFND TO RE-.. .___..... ... ..... __..... _•_. _" ,__._ .. . -.,. ... SIDL IN.THB ABOV[DE9CRIBEO RESIDENTtAL PR�BRTY, � - " SKsMATUtiE _.. _ /�y ' (. . . . . . _ . _ .___. ... . ... ..... ....... .. ... _ .. __... OFPERMI7TEE \rL/ V �� � .. . ._ . . . ` _ f _ � :` , 2� ! _ ` !.... ��.: _ � � -- _�� .,, . �. ,I-: ��-_. ' �-_ ���- - � ... � � ,I r. �i , ; i 1 �I � . Q , �. �' - � � F . 'f l . ` �'' _I I `� t ' �N ' -_ � . � � '. - _ ��� �. ' � ' 1 , � ' .'. / .. %1' . '. .-. . ; , . � � 1• . ^!% �! � _ � �" .�'� ,. _ .''. � _ . f. �1 :��. . . � .. { , . � _ ' �i. j: -. .. . - � � � " � �i. . ' � �_ ; __ --' ' . � . . I�. , '. � � ' � , , . � . � _ � � . �. �� ; . . - .' �' -i 'i � a . . . � 1 , :` .. , . _ . � . � �� i. ..� ..J� � 6.. . � _ � . Q -Q� • �y jf � , w - .. �U]z � N.. . ' I � . ' ', ' ' ' . . � , � �. '- O p•.' u' , ' a �'. W []m� ��. O �'r , I - � II . : , ,. d '.' . � . . ' . �,, , .. ...�' .. � C7Q .W �� 6. � � -� 1 ' I �, I� "__ _"', . � � . - . z-.' cx '�3r-• . _.p . !y '. i � ,�,. ..., - - - - . =a ' z N W.,. z J o. o , __',i � i ii , ; � o Z�� ao�:z v , � z- - �o _ I - � o � •oa;, �� ,-� N i I� - ? � �w�u, :-Wv` a _W ' � ' + � , , . w -' `z u'Z� LL`i p-_ a . . �' , o[ m �:�f-� Q��'._'�� . • ---'� I ` ' '. � - � d � � 'Nin 'O ;O ' � � I I � I ' W t � Z? r � Q ',.Q w in:• . z ,[p ' � . � , , �: . � w �.w 3� W in�' Y ��,� . . �, � � � 'i Z u "vw��. Up�--,.: U .(a,J �. . � 1 , ' � � Q � Z �ZtAQ ?a z Z , ... .. , u. ^ N � Q �