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HomeMy WebLinkAbout1088A (5) - ,� ,..; ..... . ., ,. r_m.�.� ._ _.,,�,�.,.. , , , ,, . � � I 76A642D CE808(REV.b/78� 1/79 �qPP'L1G�4,T[�1'J FC�i� �'�RMIT ' Os �E�JEF� — SE'ili/�C�E CdI�PC�5A1_ I'�, COUfdTY OF LOS AtVG�LES BtJllb!loiG AN�SAFETY FOR APPL6CAtVT TfJ PILI IN oISTRIL7 ti0. GROUP MAP PROCESSED 8Y BUILDING,. /� � „�y ..��� �.yV �� r '. ��"/ a.e1 � �G / ADDRF_S_:=J^lL..C"` � � G�C�NNECTIOIV QATA LOCALITY : ��� —y"�' NEAREST R y STATIOI! DEPTH �e� CROSS ST. r g a� / UPPER � �,,) u MANHqLE REFERENGE �X OWE OWNER �'�'('" - TYPE 17F GONN�CTIpN LENGTH FROM MAIL � ' 1 V. CUR6 .L M.L.TO P.L. ADORE55' � : '/�/ P.C.NO. �P`J �.�'°' � s� CO.IMP,NO. JOB NO. s�C',,.d CITY ,�� TEL.NO. ..�� , LEGA TRIJNKPEf1MITN0. ROADPERMITNO. DESCRlPTION LOT NO. �� RFFIDAVIT VJAIVFR E/tSEMENT RECORD.INSTR.NO. DATE 6LOCK TRACT NO.OF 8LOG5. SIZE OF LOT NOW ON�OT HWY.OR ST.WIpENING USE OF BUILDINGS � STA"(E EIdCRO.oCHMENT —_ � PERM IT NO. 1(dDU57ftiAL CqN7RACTOR WASTEAPPROVAL ADDRESS !6.i.� �� ^ 1. A � 0 CHARGES F--�. 4�X_. il �� ? GOPdNECT10N CHAFdCaE FEE CITY ��.{J�,�. TEL.NO. �� �� �J� o�„ STATE tJ : " � LIC. !�B� RF.IMBURSEMENT FEE . . � i LICENSE NO. CLASS rvo. DESG iPTION OF WORK FEe �,��R�V.�1LS � � ATE INSPE T 'S SIGN �TURE � HOUSESEWERCONNECTINGTO '.� t '� I PUBLIC SEWER PiEW HOUSE SEWER � p� �'� SEPTICTANK,SEEPAGE PIT OR � ��. PITS AND/QR DRAINPIELD CONNECT ADGITIONAL S� '� HOUSE SEWER CONNECTING TO BUILDING OR WORK � �ds �. PRIVAT'ECbISPOSALSYSTEM &b� � SEP71C TANK,55EP,PCTfS) CpNNECT A�DITIQNAL BLDG.OR AND/OR�RAINFIELD s� WOFtK70 WOUSE SEWER ' OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPpOL ❑ DRVWELL❑ EXTN.,CESSPOOL,DRYWELL.MANHOIE �I ALTER,REPAIRORABANDON HOUSE � - ALTEFE,REPAIR,SEWER OR '� SEWER OR DISPOSALSYSTEM SEWAGE pI5Pt3SAL SYSTEM - DISCONNECY'PLUG AND � i A6ANDON HOUSE SEWER BACKFILI SEPYIC TANKS❑ � SEEP,PITIS)� CESSPOOLS❑ � OVdI�ER'S Permit $ � AU7HORRZATlON TOTAL FEE �� ��, dALiDATION ��� � I �i (, I HA4E AT TMIS DATE A CQNTRACT W�ITH THE HEREIN NAMED CON- . TRACTOR TO GONNECT THE ABOVE DESCRiBED EXISTING DWELLING � y f'� � TO TME PUB4.IG SE � �?y� � "� g 0 'e,) � SIGNEDTHI5 �DAY F �__,_39� (� ('� r,. '. OWNER OR .—_ ..{ �q ��"��_ Ci.t„t 'yj . . . b OWNERSAGFNT � �y � �{ (� ADDRESS 7.iL./ �4'?�°' _' @ �J�S.;'�.J C � . I NEREBY ACKNOWLEDGE THAT i HAVE RHAD THIS APp�ICATIC?N t �@ �j ANb STATE THAT THE ABOVE IS CORRECT ANp AGFtEE TO GOMPLY [;{i e �I'�"V�� ' WI7H ALL COUNTY ORDINANCES AND 57ATE LAWS REGULATING � PLUMBING AND SEWERS. � 1 HEREBY C6RTIFY THA7 1 AM PROPEFLY REGISTERED AND/OR LICENSED AS R@QUIRED BY LOS ANGEl.ES COUNTV ANp STATB OF CAIIFQRNIA OR TFiAT I AM THE LEGAL OWtJER OF,AND INT�NQ TP RE- ISIDE IN.THE ABOVE OESCRIBED RESIDENTIAL PER7Y. C"� SIGNATURE OF PERMITTEE ds.��� �I,Y,,i... . ... ,. . . . . ... � . . . .. . ' . . . . � . . . . . . '�'r� . . . . .+�,�.xiw,. . . .. . .. . .,......�,..�—..�-�....as. ... .�........,a.T•------�._'_ — _ � �����PA��'����'�S� ���������$�����`eaa�a=aa��� 1. tl`�JDI�A��. AL3_ f3J1�C?ii�at;aS C��6 P�tC?P�RTY. �N�m.H�. �__...�..._��.._.______.�,_. s 2. I�al�!��aT� �°,i�D �I?Ut��J�l�I� �EaN`��E t�lS���o�� � S/�Yq,S�TElVt�s �7pJ��T;� 7i��7p-??9�T,t3�Q��.�i 9c� F�'tJi�C?l��C`aS . A41V�'?�ELt�.1t"��81F�S34L�, . . .� `",..i ._.. .. ..a � c` d",. .a .,�:e . 3:i�ll�I��T� S's�� �f 5E�?I� fi��lC-��rTN C)F SEEP- ` F�GE`�I#i�l -Sl.�E Q�a:,ESSPt�C�I.(Si. _ —�-�^' 4 EN��C:�-��E?�itJ�l�!�7l���.�'fu�Qfv E=i_�T. � ' �Tr y `f` � . � ;�"� 5. 1�4C�l��TE�C7TH ST�EETS rF�Q�N��. � . . _ � , .. ,.w.�. , � ��� -�� - .,, ,f�� ,,. � . , ��:��,;,;��, ._, ,, .. ,' r� � � �s �.... s � i � ��»r�l�.���'f/'� � 4 1 y---�__�..� � f FIELl7���FES � �{ �r����. ;a 37 ...,a.����e..s...�.�.....e..�......�.o..._«e........�..�.>�sp..o. . . .d�� S� a.:��...X Y �� ' . . I7 e . ..�i:.'� + '+ ew...m....m...�....._....._.�... „ a<...,... .;I . . . . y .. � , ' �� ......_..m.. . . .�_ .. I� I j ...�, ..._.e..,.,...�..._._.�_,�..� �`�m - i !� �... �..'_`._"'__�'_�e_� ' .-_ i� . . ,..„.�.._�......__.�....._—�.._ ..,_ . . , . ' 1` . , A!""-, .. .. . - i� i _ ..�_._. . ,..�___.._.___.__.... �.._,_.... _._._._ -- ,i �