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Home My WebLink About1056A (5) #�. . .. . ...:.... ...".:,.' . � _:..-. . . .3 �:7.: a. r;.� .. .,,prml .. '�t . ,�. -...�....>_ «.. . . , . . . ` .". .. , nv.:en..,p:. i.�ae^xn'.w. .,..xYw,+v,,. ..nm.,w..�».-v.n mm�:...,..., ............ � : 1 � i 76A642D � � � �� CE808fREV.6/78)1/79 �,PPLIG�T��I�I F't�-R �'�RIl/lIT � 05 S�V1/EF2 - �EVV�C�E D1�PCaSAL COUNTY OF LOS ANGEB.ES Bl1iL[31Nfa AR�D SAF�TY iFOR APPLICANT TO FI�.�.9191 oisraicrNo. caaua �K MAP PU PROCESSED BY � BUII.DIhiG w^7 � J �� ^' � A�ORESS ,�„r� � r G�{ �% �� LOCALITV � � ^:. � ��NNECTION DATA . NEAREST �� S7ATIQN � r{ pEPTH / CROSSST. �.,. , "� a f R7ANHOLE REFERENGE 4(,O�� OWNHR E.�.�� TYPE OF CONNECTIqN LENGTH FROM �' MAIL .�7 � , � 3� Y. CUR9 M.L.TO P.L. ADDRE55`. � , , - P.G.NO. . �^"IJ�'�'� � fJ CU.IMP.NO. JOB NO. [;a(' CITY �a��' TEL.NO. "�� LEGAL � 7RUNK PERMi7 NO. ROAD PERMIT NO. . DESCRIPTION LOTNO. ,� �� AFFIDAVIT 1VAIVC:R 'cASEMENT RECORD.INSTR.NO. DATE BLOCK 7RACT NO.OF B�DGS. S2E OF L07 NOW ON LOT HWY.OR ST.WIDENIIVG U5E OF OUILDINGS 9TATE ENCROACMMENT PERM IT NO. CONTP2ACTOR '��' INDUSTRIAL - WASTE APPR6VFIL A�DRESS ,�,[ 'y��('l �� , __.� � GHARGES -`-"�"-T y. CITY �'a�_�(,��,e,�"� TEL.NO. ��;j V�' CONNEGTION C.HARGE FEE �" STATE ��.,,o � I..IC. �� d. REIMBURSEMF..NTFEE � LICENSE NO. ClASS NO. DESCRlPTION OP WORK FEE �ppR�iOALS � . DA7 P TO �SIGNATURE HOUSE SEWER CONNECTING TO � PUBLIC SEWER SEPTI<.TAN6C,SEEPAGEPITOR � NEWHOUSESEWER � PITS AND/OR DRAiNF1ELD � a� CONNECT ADDITIONAL 4 HOUSE SEWER GONNECTING TO BUILDING OR WORlC � 'ARIVA'i'E DISPOSALSYSTEM � C�D - SEPTICTANK,SEEP,PIT(SI CONiVF_CT ADDITIONAL BLDG.OR ANp/OR 6RAINFIELD � WORK 70 HOUSE SEWER __ __ "'° OVERF�OW SEEPAGE PIT,DRAINFIELD � C65SPOOL ❑ pRYWELL�] EXTN.,CESSPpOL,DRYWELL,MANHOLE RLTER.REPAIfdORABANDONHOIJSE'�� ql_7ER,REPAIR,SEWEROR SEWER�R DISPOSAL SYSTEM SEWAGE D15POSAL SYS7EM � � pSSCONNECT PLUG ANp ' ABANDONPi0U5E5EWER ElACKFIL.LSEPl'ICTAIVKS❑ . ��E��y Perm it $ � . SEEP,PIT15)❑,CESSPOOLS❑ AUTF�ORlZ�TIOtV TO'6A6 FEE ��`2' �A.�.rDAT10EV 1 HAVE AT T'HIS �ATE A CONTRACT WITH THF_ HEREIN NAME!?CON- TRACTOR TO CONfJECT THE A80VE DESC1710ED EXISTING DWElLING �' � �t�'F�},�.� 70THE PIJBLiC SE }J�� "' SIGNEDTHIS � DAY F 13!� �S� R �a �� 1 �- OWMEROR �r�q-- OWNER5 AGENT_ !d � �',�r�l� . . 4d � � g c, � �'L�� ADDRESS_ 7 ' ' i 4,�_ y I MERE6Y AGKNOWLEDGE THAT I HAVE READ THIS APPLIGATION '�� ' '� �E i .;!43'. � � AND STATE THAT THE ABOVE IS CORRECF AND AGREE TO COMPLY �� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING P.ND SEWERS. ;,� � `� Cj1.-��} , ..,. , I HEREBY CFRTIFY THAT 1 AM PROPERLY�REGISTERED AND/OR � LICEIJSED AS REOUIRE� BV LOS ANGELES COUNTV AND S7ATE OF �: CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND Tp RE- '� SIDE IN,THE ABOVE DESCRIBED RESIOENTIAL PROPERTY. � SIGNATURE ,A^.,�, " OF PERMITfEE v d'��^�' . .. .. .�:.�.�.:._..:�.:; ., , , . , .. . � �...,,+,«�,A�«; . ..�M�-. . e.__..._.�,_...�....Wu.3..��-.::::.az-...:......,....�..-.. �.- � �f��R�`f�E�T�15� ��:�3�R��§��4�,�°6�� l. !�l€3iCA?� ALt. �€�,?DIf�9GS C�N ��ZC??ERTI''. ..�.......�_�� 2. i�lCl�ATE /a�� ilv1E(�l�I�I�i SEI�J/',C7E €�IS3�S�1L S°fS"��M �'v`iT€-i �IE C3�STAf*l��S TC1 ��1!E.�I1�lG� , � # Ai�EU PRv�E2T�°�if�.!E5. ,`�;" " :';�,�.°" '.�, , .^ .. 3.1�C��1;� S��E f�F SEC�Ti� T�,�!K-C3EPT�s �r-S�EP_ . . `" . �,GE P�TfSI •5��:F��;F��;:aL;.a). �:: ;; �...� :..;r, �,�r , �. ��Sdi��i�@4Y,J7StlCi tJ1�iS��.�d�tV�fV t"�4J�. �,, `', ,� :tr..p+ ��,-wr....��.��..` ,.5-�+:� ,�.i�.�S i ,�5�.: .� � �-.�,� f ja .. ..� 5. I�;�!��7E 6�F#��R��`�S[��ie;�R. .. ___ .W „ :"� �- ... . . ,� w w ..k�.� . .-., � � ,�.,�.4. , � y i�do l. S '9 68 �.F . Mr. - .... .. ..;..y=�c "'"w S Yi.$kpv. . . . , ! 1 .Y«S'aY'.`;. �.A�.�2.A w �51 ��.nJ.�. R ��' . _ � .x r... . � .."�'.. .._«:. . . .r'..}`.i. � .a ...... ' .... - .,.J� � 4 i.. d..+ �... .. .,. 5T.!"@LLE�° �f�' �� ; __.__..�._.e,�... � ', '__�_. ; F�E�i��IQT�� -- �_,.. .s.�..�,�,..�. S � . . . . ��;�il -....�-�.»��+�..��.s..�...�.....e.�„� .. . � , .. :4•. .....�.. }.+��. .