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Home My WebLink About1093A � -:::.-. .,,..., ,:,,. �.,.....:, . .._ .�.. _ _._ ,. . __ � 76A642D � CE608(REV.6/781 I/79 /� n��r�� n��pp ��+ �S !',d"' I r IVI H ��/�� - �� f�'��.., COUNTY OF LOS AN�ELES �UIL�IIVCr AiVD SAFETY FOR APPLiCAhlT'�(9 PILL IN o�srR�cT No. �RQ�1P MAP PROCESSE'�BV �] �fTf BK �g G �•�' BUILOING �� (-- ��A� . . . ...i/ �) s� �.Ps ,.�� '�,� ,�`�'"' l AQDRE55 y4,e,� 4f�, ,1 LOGALITY '_�,�J - � 4.:J''" ____ �AIVIdECTBON DATA � NEAREST � j/ J STATION ,..,.L.}t....4� DEP7H 'r� CROSS ST. _ �: F ��t -� ^'��ti'� �K•��.� �� D � UPPER MANHQLEREFERENGE LOWE OWNER � � TYPE OF CONNECTICDN LENGTH FROM MAIL ,�� =-�C� e Y. CURB P.L. M.L.TOP.L. APDRE55 �i- r CO.IMP.NO. JOBNO, a.�..dCr( GITY TEL.IVO. "�J�.�� LEGAL i'J TRUNdC PERMCT NO. ROAD PERMIT NO. DESCRIPTION LOT NO. �17� �� AFF1DAViT WAIVER EaSEMEN' RECORD.WSTR.NO. DATE BLOCK TRACT - NO.OF 6LDGS. �. 51ZE OF LOT NbW DN LOT � NWV.OR ST.WIDENING � � � � �� - USE OF BUI�DINGS S7ATE ENC.RDACHMF_NT PERMIT NO. CONTRACTOA INDUSTRIAL W.4STE APPRQVAL ADDRESS �( GHARGES CONNFCTION CHARGE FEE CITY TEL.NO. ��.-� � �- L CAENSE NCa.��1+�� GLASS (,,,.^"'�� REIM6UR5EMENT FEE � �..c-oJ- �,d' NO. DESCF21pTION OF WOF2K FEE qpp�py,��,S DAT EGTOR' I NA7URE � HOUSE 5EWER CONNECTING TO t+�y � � PU9LiC SEWER &` .� SEPTIC TANK.SEEPAGE PIT OR NEW Fi0U5E SEWER PITSAND/ORORAINFIE�D � CONNECTADDITIONAL � � HOUSE SEWER GONNEGTING TO BUILDtNG OR W062K PRIVATE[J15P05ALSYSTEM 5EPTIG TANK,SEEP,PI7151 � CONNECY ApDITkO1VAL�6lDG.OR AND/OR DRAINFIELD � WORKTOF-0OUSESEWER � � .mo OVER�LOW SEEPAGE PIT.ORA(NFIELD CESSPOOL �] DFtY1NELL EXTN..CESSPpOL.DRVWELL.MANHqI_E � � ALYER,REPAIR ORA9ANOqN HOUSE� �� - dL7ER,REPAIR,S�WER OR SEWER OR OISPOSAL SVSTEM $EWAGE pISPQSAL SYSTEM - ; 615Cd14NECT PLUG AND ' ABANDQNFIOUS65EWER BACKFILL SEPTIC 7AfJKS Q �yy��R+§ Permil � �+, SEEP.PIT1Si[,] cFssaoo�s'_7 Al8T9i63131Z�TION TOTAL FEET (�� V.�IIDATIC36V : I HAVE AT THIS DATE A CONTRAGT WITH THE MEREIN NAMED CON- TRACTOR TO dONNECT THE ABOVE pE5CRIBED EXIST(IVG DWFLi_INC , y r r.� �;_ �` TO THE PU6LIC SEWER = 1 �y y � /) ' SIGNEDTI-115 / DAYOF ` 7� owNeROR r }i� ° � ° �� ('d OWNERS ACiENT ' - � ADDRE55_ � '�d '"a�.•�',�� C1. i„}�^ . i HEREBY AGKNOWIEDGE THAT f HAVE READ THIS APPLICATION / p, � AND S7ATE THAT THE ABOVE IS CORREG7 AND AG12EE TO CbMPLY 9 `",�,g'� C.4�l;�4J 4i - WITH ALL GOUtYTY ORDINANGES AND STATE LAWS -IdEGULATIfJG PLUMBING AND SEWERS. 9 1 HEREBY GERTIFV THAT I AM PROPE�LY REGISTEqEO ANO/OR �,,� � { ``� '�+'^(�j�Lj LICENSED hS REOUIRED BY LQS ANGELES GOUNTY AND STA7E OF CALIFORNIP�OR 7HAP I AM 7HE LEGAL pWNER OF,AND INTENb TO RE- SIDE IN.THF AB�VE�ESGRI6ED RESIDENTIAI.PROPERTY, r'^ SIGNATURE OF PERMITTEE _�� - :.,...,.;n+.�+.� . . . , . . . . . . . , : ��R��A��5� , �a��5��a�be�a�§�� 1. ii�l�;�,'��'E fa;i.�. �iUI�.Qlz�1C',� C7�! PRCIPERTY. ....._��.._.,.�.,.�...._.�.. — ---- 2. I�it�l{;;�,TE x^-,i�!€s s?I��1!�4v�iiiei�! S��.td�1",�`E l7i$PCS,�R_ SYSTEP�1, irVlT�i T(E �lSTA��°ES TC7 �3UILDfl�•€�S. k ,. /�NC?P��PL"l27�i° Li1�3�S. . .3 �;` t d .. 3.Di�3[�IC�TE S�� t'�F S�P��C TA�°vK-��YiH �s=SE�P- ` . ' . ,4�vE PETtS}-��-��`:��r^;J�L;SP. �..'- L. ; 4. 9�,lI7IC�l E i�C?��'�1�IR��`('i��11 i�i'� �LtJT. � ... ,. . a , ,:�::r, � k.�. 5. li��l�T��ST��;S iF C��;�ER. ' .. . � - � . . : .. , . A. . 'b` .t.r.,'i t .. �..3.,,.. � -�..�,�M� . , - Y d , .. ,. .. .. � . , .. . �.. ' . e. .. ��,,:: .. . "-:S"�.�'.��. .��.d.� . . , ' .y.;.._ � . . ;:a,.'H :r��i..: �.�.."x � Fk��.` ..:�'i.�4 �'_ - . .. .. ,.��.;rr '. . , ��. . .,...��.S.sA ,,a ..... " ' � . ,.. � ,_ . , ' -.,. ..,._., . . �, �.. , .....�_,. . -.. _ . �.L :t.... .. �-.. STe ALLEY R/'�a' � - � �� FlEL�N�T�S �.T.�. —--- � � .�;..,. �___�__,___ ._._____.________._ _� � � .�.