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Home My WebLink About1054A (5) i� — .,,, ,.., t.�, . ... : , _:,.� ,..,. . .,.e._ . _ � 76A642D CEBOBIREV.6/78)1/79 /� ��j��y�A' �� ^�' ��A/0i� OO 5 r'1 N 1 r Y—" l�/l I ��9d�lER - S�1/l/�GE [�1�F'��A:L. CtaUiVTY t)F k05 ANGELES �Ufl[�IMG AND SAFETY FOR�1PPLICAPIT tO FIL�.IN nisTRicT,uo. c uc MAP PROCESSED BY BK PG BUILDING x� / � t � �� ADDRE55�r � • (,. ,�.+aj LOCALITY � � � {, CO(V�rIECTiON DATA NEAREST ` STATION y-yer DEPTH � � CRp55 ST. ,�„ . , j° "� �� - , . $aq � / � UPPE MANHOLE RE�ERENGE {,'�(}'p OWNER ' .� qC . . � � � c . . .. TYPE OF CONNECTION LENGTM FRpM MAIL �� -� �/�� Y. CUR6 P.L M.L.TO P.L. ADDRESS�„��) �{ (G' �^, �,�� . . �) . P.C.N4. � CITV lA��'f,,.L�.�� aTEL.NO.�J ��"��.L,,.- CO IMP.NO. J06 NO. "�. LEGAL � TftUNK PERMIT NO. ROAD PERMIT NO. �ESCRIPTIOIV LOTNO. ��ry AFFIDAVIT WANER EASEMENT RECORD.INSTR.NO. DATE BLOGK TRAGT NO.OF BLDGS. � SIZE OF LOT NOW ON LOT HM7Y.OR ST.WIDENING USE OF �BUILDINGS STATE£NCROAGMMENT PERMITNO. � 4 CONTRACTOR ✓�jy� C� "�„f,a� �NDUSTRIA� WA5TE APPRCIYAL ADORESS �q.t„�.'�„ • __ CHARGES CITV {,,,�...�. TEL NO. �ji .��S� COPJNECTION CHARGE FEE �� LICENSE NO.�� ClASS (�,-+I�� REIM6URSEMEN7�EE � � nlo. DESCRIPTIC/N OF WORK FEE APPRO9/�LS � � DA � 5 EC OR'S SiGNATURE � HOUSC SEWER CONNEC7ING TO , q�Jz, � PUBLI�SEWER E SEPTIC TAN}C,SEEPAGE PITOR NEW HOUSE SEWER �en PITS AND/OR pRAINFIELD � � � COIVNECT AD�ITIbNAL � HOUSI_SEW[R C6NtdECTWG T0 , BUILDING OR WORK � (�;, PqIVATE DlSPOSAL SYSTEM �y` SEPTIC TANIC,SEEP,PIT(51 CONN�CTADDITIONALBLDG.OR �,' � pND/ORDRAINFIELp � WORKTO HQUSE SEVNER OVERFLOW SEEPAGE PIT,DRAINFIELO CESSPOQL [] DFdYWELL❑ EXTfV.,GESSPOOL,DRYWELL,MANHOLE ALTF_R,REPAIRORABqNaON'HQUSE -� �� ALTIER.REF'AIR,SEW�ROR SEWER OR dISPRSAL SYSTEM SEWqGE pISPOSAL SYSTEM � DISGONNEGT PLUG AND � AIBANDON HOt15E SEWER BAGKFILLSEPTICTAPdK$[] . O�d1IP�lER S Perm it $ �3 s�eP,aiT�s�❑ cEssaao�s❑ � AUTHORiZA,FiON T07AL f�E � , ��4LIL1,�714'�DN � � �!`s�ftA I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN.NAIMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST!!VG DWELLING TOTHE PUBLIC SE,'��/(E x�n�'t �} � �� '� � � SIGNEDTHIS �" DAYO 19�✓�✓ $� / �� OWNER OR �� z�'� � +✓•L' � � OWNERS AGENT g� q ADDRESS_. . .. �� ?s �".'�i �.�.,.`,j L.� I HEREBY ACKNOWLHDGE THAT i HAVE READ THIS APPLICATION � %; f,l i� ��'.�1„f AND STa\TE THAT THE ABOVE IS CORRECY AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND S7ATE LAWS REGUTATING PLtJMBING AND SEWER5. � ' 1 HEREBY CEF?TIFY THAT I AM PROPEFiLV REGISTERED ANp/OR LICENSED FlS REQUIRED BY LOS ANGELE5 COUNTY ANL1 STATE OF , CALIFORNIA Oi2 THA7 I AM THE LEGAL OWNEit OF,AND 1NTEND TO RE- � SIDE IN,THE ABOVE DESCRIBED RE51DE'NTtAL PROPER�Y. ; SIGNATURE OF PE62MITiEE '� '� ...�...,�.ss,�,.mr.�,�..�..�me�w:w,w� . . ,„�.�w.�z ,. . . . , . . .. . .. .�.,........_..�......_».....,..slfi. - � t ��F�'��T�5� ��43F�"�..��'a«Y$°��.k�°.��d4?5"9 . � e_�,m�...a.......��__._...._...•.a.-a�•, _ _ i. 1N�ICAT� ,�,L� �tJlt.��I!�1GS C?f�! PR4�PERiY. 2. li�1DiC�1iv- A-,�9i� CI?:,!�EI�;S{�I"� S�4/VAG� i�i5°L3SR� SYSTEl�1 1��!1TF# TfE Q!STANCFS TC3 Fl1il_�li4t�S . t_ ,,�z,,,�,;'' ANt��RC)P�RTY i(fdc5. , ,�� ,� , �, .;� ��„ 3. If"�£�i�f`,T� Sl�E �i� S��''6ii,TP-t�aiC-�EPsH C§� �E��'- ; . �_.;, �laE P!T{g} .,cil��C3r��SSPC�'t.P?,!_iSi. ,-�. , _, _�'i �;�`.' 4. IR�[al�,�aTE N�'RT� �al2L�TI�''aP'��'.1 PL�Ta , , � ,, ,..: :s.,.�, � ;� ^� ,.�-'� :� '� :.� 5. 1��I�A�`E�3�T�#�i REE3'S i��7RI��Re . -. , ,� , ., . ' .. ,. . . _. �, �. . . ._ . ,� , �`� �„ �� .. _ . '.� ' ;;?.,.V'� .:x„�'. . .;°k . . . . .... . - , . , _;.si_.I-v . ..� "�YI�•.y�,si�r,.�,... � .� y i�.. ., ,., ;.. �. . .. ., , ,,. ,,.. .. .J ..i �.p -.., . a.,,�,,::�.. „i.. .,.' � .. . ' . r ' ,., . . '�. �... �, t• S�. ,. � �To�"aLL��I RI�b" FiEL�i'�QT�S ' , r..;. . :,:_ ..ti ,: >,� __� — ____�.� —�.�� . . � � �.� .