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HomeMy WebLinkAbout1052A . ,,:... . ��,....y:_ ...k�,?-,. r..:h�; ,t.r:� . ¢.�r;� ww t-- � �r �,se� q�-n'4 w �Ak>x � o y� �. � � �z .�x, _ . , . � .. . , ,. j.. F .� . . '':T- . . . �* � , . . . . .. . . . , . .�:I�:tiS�� }�SZ s$�C y�•.�. . � . . 76A642D � � - CE808iREV.6/%81 � � � 05 APPL.IC/�Tp�N 1F'+�R P�R�1II[,T �., ;;F & �.� ��.� , ,. . . _. ., . �, ..,, � � c�i��c�si� , �EV1SE R,,.- S E1NACa L- COUNTY OF LOS A,NGELES BUlLDINC�AND SAFETY , ° ` '-� ' FOR'A��LI�AN4'[C3�ILL thl � �ISTRICT NO. G UP ; MAP ' � ' PROCESSEO BY BUILCIING � �" /� /�., �/� !�� �� �� � . ADDRESS : . (..+ .7 . .., � �.d.1�1.t!1 ;, � , � ,r 4 'p.�r �y .� � . „I. LOCALITV � ' � ����� � �Q'a�^'""T�i/Ii DA�/'6 NEAREST � ' f . . . . S7ATION � ��'dI� REPTH ."���.� � . CROSS ST. f ' J ;�+' " � ;.y ,y°� � UPPER ' � //�� MAf�tHOLE REFERENCE �g��f�- � �.,� OWNER' rI �f;�,..; � L�7:��� `-�'_�t� f' . . .. �� TVPE OF CONNEGTI6N�" �LENGTH F�ROWI MAIL 6'. . � `� .. . Y. GURB P.L. M L TO P.L. ADDRESS w �P�J�. , r�,d r", v�. . .-`4 t . ,�j �*�''' . . . P.C.NO �!'h` eEJ' _ ..,.: CITY TEL.NO. ���? �"�'p�+ ^t'.:,. Ci? IMP,NO. �� J09 NO � ` LEGAL TRUNKPERMITND. ROApPERMITNO. DESCRIPTION LOTNO. ,+ �. � AFFibAV17 WA'.VER EhS[MENT RECORD.INSTR.NO. DATE BLOCK TRACT a�Z NO,OF BLDGS. - � - � �� � SIZE OF LOT NOW ON LOT HWY.OR ST.WIpENING USEOF STATE EM1tGRQAGHMENT -� - � � � � BUILpINGS P�RMITNO. � �� � - . . . WDUSTRIAL �. . '. , . ... . � .. . . . ... . . , . CONTRACTOR .F.. J,t,+'..d-^ WA$TE APPiiQVAL � ' ADDR6S5 „��) � � ��. ��� ' ! CHARGES � ,j� }� � � CONNECTION CHARGE FE� C17V ,i'�.r� TEL.NfJ. "'"� .^.��`n`. ��:' 4 y� STATE s�7 L+"^''r_:,.+�. . � �LiC. �.;" REfMBURSEMENT FEE - � LICENSE NO. ,aC , r �' CLASS �"� ,�.a � ' NO. dESCRIPTION OP WORK FEE � �pP�Q���s' + pq I pEGTO SIGNATURE � HOUSE SEN9ER CONNECTING TO � � /2.-,$g - � � PU�LIC SEWER d`6T - . SEPTI'G TANK,SEEPAGE PIT OR- . , .. . . .., . , NEW H4U5E 5EWER �� PITS�AND/OR DRAINFIEID'� � GONNECT ADpITI4NAL � HOUSE�SEWER CONNECTING TO - BtJILpING OR WORK PRIVATEI]ISPOSALSVST�M � CONNECT ADDITIQNAL.BL�DG.OR� SEPTIG 7ANN,5EEP,PITIS) WDRKTOHOUSE'SEWER'. . .. . '. .... ..":'. � .. ...... AND/ORDRAINFIELp ..., ........ pVERFLQW SEEPAGE PIT,-DRAINFIELD CESSPOOL ❑ ORYWELL Q EXTfd.;CESSPOOL,DRYW�LL.MANHCSLH . ALTER,REPAIR ORABAND'ON HOUSE� AL7ER.REPAIR,S�WER OR SEWERpRDISPOSALSYSTEM ' SEWAGEPISPOSALSY5TEM ... ... _ .. '_.. .. ;_., - .. ,,.,..... ....,. .... �Cii$CONNEtT-pLUGAND.. .,... .,......_.. . . .. . . . . . . . . R9ANDpN HdUSE SENJER � .......,, �,......, ..... 6AGKF"ILLSEPTfCTANKS[� �...-. .. ..,.. :_. ... : . . . . ..� ... ..... . �..� SEEP.PITlS)❑ CESSPtlO�S u�. . OWa!iER'S Permit � �. ._.�.__....__.-•�.-- -•, '1/ALIDATiQN `: —. Al37FtOitI�A�`IOfV TCftAL FEE _ �j > ` ":` ,° 1 HAVE AT'THIS DAT�A CONTiiAGT WITH TH6 NEREIN NANIEQ CON- .. ` � � �'1 �� ( . . ... . . ........ ........ ,..... .. _.. ... TRAGTOR T�p GCSIVNECT TI-IE ABOVE DESCRIBEO EXISTING DW„��.,LLING TO TNE PUELIG SE R. - � ' - � .�'�� .a2�� `u; � ��. � SIGNEpTHIS ....... ...,,,r� DAYOF ' - . .. , t�{'. . . _ . .. ... .. ... . . .._. . , . - ,. .... . . OWNER OR � t � :.( G Qk '�y..C;�.�. � . .. OWNERS AUENT . , ..,... . . . . � __, ..... " ... . . . . . ..... .:-.. _.._:. ... ..... .. ....... . .. . .:.. ..... ADDRE55 . � �` � � j�:-�;`, „ .. ... . I HEREBY ACKNOWLEDGE 7HAT I-HAVE READ-TH1.5'APPLICA716N � ����-°�" � ' � -� � � �- ��" -�"'- � � -`� '� ��� ' �-'� � ANO STATE THAT THE ABOVE IS CORREGT AN� AGREE TO COMPLV � !"; P y C:�-, -- � WITH ALL COUNTY ORDINANCES ANp S7.4T� LAWS REGUL.4TINU '� ��' " ' " � - - PI.UMBlNG ANO SEWER5. �;...... . . .. ... . . . .. .. . . . . ... ......... . .. . . . . I HEREBV CERTIFY THAT I AM�PROPERIV REGiS'Y'ERE6�ANlJiOR LICENSED AS REQUIRED BY LOS ANGELES COUNTY-AMD STATE OF GALIFORNIA OR THAT I AM THE C.EGAL OWNER OF,'41VD�INTEND 76 RE- , .,,. ,.,,, ., . , SIDE IN,THE-A.BCbVE q�raCRiBE�?RESIDEIV7���PROPER�Y. � �� � � � - � � �� SIGNATURE. _. . � : .. .. - , . .... _.. ....:: . . ..;..-, ..... ..;.... ... . :,�.. .,...,.�..,.,.. OF PERMI7TEE � �-' } � I . . . .. . .... . . . . . . .. �...... , „ . . ... . ........ .. .. . � . - . . ....._ .... . ..�_, . ... :...... . ................. ... ... .... . .....,. , . ..... . .. .;..,.,... .:.�.,.�„r. _ .._...�. . .M .,�.,,..,. .. . ,,... .. . ...._...,-...w, .. ,..; ._ . .,.......� . FOR��PA�Tf�EOVT IU$E �EQBlIRE�9����RP�d��'�0�1�„� 3 '� � �:� � ,�x,.f h ., . `� ;��?; „ ;� :... . , .. ....�> ..,� .r:u„' d ,,. :v}� a a, �7 rv"Y�:di' a.�'„ . . . - . . . � 1. INDICATE ALL 8UlLDIN�S QN; PRQPERTY. ; ,: . ;:. �, ,:w� ..,. ..., . . ., .., . .. . .r s�y T..,'S.;` .'^.:` .... .' ,.,.:'.-. P a:.c� . Ti cS�t C�.�.,ryk' ... ..�,�.�u;3' '..�' 2. INaiCA7E Ai�1Q DIfv1ENSiON :SEWAGE DIStPQSAL �� . SYSTEM VVfTN TIE DlSTANCES TO BU1LDlNGS � P � , ,...,. r �.,.. -,,,. P,N[3 PROPERTY L4NES-_ � ....�^; �.... W,�i�,,,'��� �"� , ��.; , - . ::; h �- , 3_INt7lCATE SIZE OF �E�Pl'lC TANK-I�EP�'N C7��SEEP. � ,; ' �`` �' � ���' �w � .. .._. AGE P!T(SI -�IZEOF CESSPO�LIS). Y,µ rr ; . ��. _!�a�. „h ; � � __... , ,:..� _ e�. , � � ,_ � , , ;:<. • . , , � �, . ... _. �`,u �°"�w,'��.,�,�� .. ,, ` 4. 14�DIC�1T�NORTki t�iRECT1C7N Qf� PLOT. , , _ _.___ , .;: 5. !ND(CATE BOTN STR�ETS iF CORl�ER. ' ` ' ' '" . _ , .. . . �: _ _ _f � ,„-. � -: I � �. ,� ,.: __._. � ,��- . _ . , .. � � . .; .. .... :., r . ., .. _ g y ., , . . . � . . .._ , . . - . �:..� . �,, . : . � �_�. . .. ._ ...._ . . .. . ._....__. . .. . ......_ . . . - . . ,...'�"'.. ._ " -:_: . � .. �� �,. �� .. . ... . .. .� �, . .. .. ......:. . ..��.,, ,� � �� . .r, .. ., ,, ..._. . .. .�� . .. ... , ,,..:� . .ti:; .. e - ... ,,. . . . ..,.....- ....�_. ... . . ,... .... .. . _ . ... .... . � �, . . . ..,.. -.. :,.. ,. . �..: :.✓+ .�._ ,_. ., �,:� i�.-.. .. , „ �:. ,-.._..... ........ .. . ....,.�. . ......, �, ._.__-.. .. .,. - ... .__ . .. ... � �., . 4�,...,... �.. - � _, R/VV ,' .,� �: . ,",.. �.. � ST.ALLfY. ; � _ �_ _ ,� - _ � �,.__ . _._ F _ „� �. � � .. _ . ,. _ __ _ . ..,�_.. .. . . ._ .r. . � , �; , ; ,: � r. ' :�.. , ..a�:.,: .�k .. �II .'�. 1 {. � ...... ...........,.. . .. ..__.... .. .:.. . . �,�, . . .a F' Ir�} � 'r � f;l . ......... .._.. ......... . ... .. . ...._.... . ..... _. . ..._.. j. ......CS . � . .. . . ........ � �'," �. "iA� _,."�I , . . , .., , ... ,n �".. r.�. ..,; „�..s'.:� _. .. _ _...... , .�-�; !�8 e . . •- .,.:�a�, ..�,,...:� .: ,.:, ,. ,. .::. a .,� �..�.�� ,_. . ._ ... . .. .,. . �; FIELD N�TES �._ � � �� � . .:� w.. a w �� - ,r_,. �i ., I . .." " .'3�; . 4:,: � , .s.w „ . _ . .I at , .�. , . , v.i . .._. � , �, . .. . . ., _.. . .�`.,7 . , ". �%:' . . .. ' � Y W . . ,. .- . .. . ....,. - ...�.:�. ..., .: .... ,..,-.. ...... .. ..,,. .s,:..4 ..� „-;. �, ,J'C P.. 5-�� -t ' � � � .., } :- . �. .�,i ) f � i: `p¢', )s+ + S i N ). 41 �� . . ' .... . .. ,. . . f^ _ __�_�� � .,, i� fis,..�:.5.�.':�11 ,l.Jr.�„;;i,i Ll�lh.,•� !•.i J C .."1:��: