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HomeMy WebLinkAbout1092A (5) p., ,.,y,, ...,, .. _.,.:. � � , ,:, „ � � _ ; . , �, l,.,.�., �:- :.i�=� �i ��{! r� a �� t�C�:'.� <�^r'.'; . , �-. � 76A642D ceaoaiQev.ena>ii�a AP'PLI��'fi�ll� F'�R P'�RIl�[T �S a�V!lE1� - �El�1lA�C�� D[��'�S.�L COUhITY OF I.OS A�I�EIES 6lJil�tWG lAND SeQ►FETIf FOR A�PPlBCAPV�TO EI�I IN o�Sre�cr No. �R UP MAP PROCESSED 9Y eK ./F/G //^� BUILDING /�,,,�/�. � �� �� ` / /, ADDRE55 ��/� A ! �r � � CORJNE�TION ATA LOCALITY ' ' � ( r--��� ' STAPION � D s�L� DEPTFi � NEAREST �°^','�'-P t�� CROSS ST. 1 — l�� ,� .. A .PP R ��) MANHOLE ftEFEREIVCE �� �,/ � E� OWNER � �'+'' TYPE OF GONNECTION LENGTH FROM MAIL � ' Y, CUR6 P.L. M.L TO P.L. ADDRE55���� _ � r �j CO.IMP.NO. POE NO. ��a.1 CITV f TEL.NO. �_��� LEGAL ^� 7RUNK PERMITNO, R4AD PERMIT NO. DESGRIPTION� LOTYO. ��� ' AFFIbAV1T WAI'JEft EASEMENT' qECORD.INSTR.NO. DATE BLOCK TRACT NO.pF BLDGS. SIZE OF LOT NOW ON LOT HbVV.OR 5T.WIDENING USE OF � STA7E F_NC(20AGHMENT 61/1LDINGS PGRM17 NO. IIVOUSTf71AL �� CON7RACTOR WASTEAPPRQVAL : 7✓, 4cV1C�L-..f. �/ _/J.„.J�'7�� CHARGES ADDRE55� ���y T�Z�P��� � �r " < - �/ {?�� GOPINEGTIONCHARGEFEE � CITtl ��� 7EL NO. (J(' STATE �." yt LIC. � /1 REIMBURSEMENT FEE ��q' LICENSE NO. _�.�, CLASS __Cy„ _ — I M d— � NO_ DESCRIPTIONOFWORK FEE �PpR���y�,s �DATE. IN E T F.S� IGNATURE O� , HOUSE SE WER CONNECTING TO �� e�v PUBLI�`SEWER �'� SEPTICTANK,SEEPAGE PIT 4R NEW HOUSE SEWEfi ,� PITS ANO/[�R ORAINFIELD CQNNEC7 ApDl7PONAL Sa�C HOUSE SEWERCONNECTINGTO Bl11LDiPdG tlR WORK &� PRIVATE DISPOSAL SYSTEM CONiJEC7 ADOITIONAL BLDG.OR SEPTIC TAWK.SEEP.PIT(5) � WORK TO HOUSE SEWER ' P�NR/OR DRAINFI�LD � OVERFLOW S£EPAGE PIT,DFtAINFIELp CE55PQOL ❑ DRYWELL❑ EXTN..CESSPOOL.DRYWELL.MANHOLE ALTEft.�REPAiR OR ABAfVDON HOUSE � � Al_TE1Z,REPAIR,SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE L]ISPOSAL SYSTENi 61SCONNECT PLUG AND � A�ANDON MOUSE SEWER 9AGKFIL.l5EP71C TAiVKS[� SEEP,P1TIS)❑ GESSPOOLS❑ C8N1IRiER'S Perm;t � Z? lsU�'HOR9ZATI(31V T�ZAL FEE � �`4B'���T��� I HAVE AT THIS DATE A GONTRACT W{TH THE HEREIfV NAME�CON- `� �(5.��) 14 TRAGTOR T6 CONNECT THE ABOVE DE5GRIb6O E7(ISTING'IDW�LLING 7 -- P� TOTHE PU9LIC SE SIGNED TIiIS DAY OF_,�� t� � . �'..� �`ro �� � �� �. . . . OWNEROR � � OWNEFtSAGENT ��sp0 rt !.3 ( `,! e � •; �.���. � . ADURESS �� ( t 1 FIEREBY AGKNOWLEDGE 7HAT i HAVE�READ THIS APPLlCA710N �'� '.� "� U `�j�°}� � AND STATE THAT THE ABOVE IS CORREGT AND AGREE TO COMPLY� PL,UMEINGANDSEWERS.�NANCES AND STATE LAWS REGULATING p� 1. �i ('5,�,�, � i� C. 7 i HERE�Y CERTIFY THAT 1 AM PROPERLY REGiSTERED�AN�/OR LICENSED AS REQUIRED 6Y LOS ANGELES COUNTY AND STATE bF CAIIFORNIA OR THAT I AM THE LEGAL OWNER OP.AND INTEND 7(J!2E- SIDEIN,TNEABOV ESCF218EnRESIDEN7IALPROP�RTY. ��- � SIGNATURE OF PERMITTEE .. ��'/�-�,,,,,_.__ .�.. . . . . . . . . . . . . . ... ... ��--.�•��,....wH..-=-...�..._.._.__.._._...__._._._ ___.� - -.,...,.�...e..n:.,,m......a..., ".�.w.«..++�..: '.,-,.�..,:-�...........:..�.;.A.� '».,...�.::-.�..'..:..::::.�:.....,:.n.: ' "� �� ' ' ��������°��a������ €���������a�;�°��r"�°�°���� 1. 31°�1C)iCAT� f-+,L!_ F!S1LC�I�:GS �?�J PRC�Pce4'TY. �__.__�� 2. i�J[�l�ATE �f�d'� L�;l1�1���!C��`�f SEUV,r.GE D15�GS�,L $�°�T�1�'1 '�'!1� �3E s�3MJs�-"tl�l.i� I�'J ��3I�.�?�I���S : �,i�.l�PR�??��l1°LIl��ES. .'.' '.: a..: � ' '' . '�." 3. ��l�iGAa� SiZ� �� $�Pai� TAi�K-�EPTN C�!= SuEF- � , ' �� . AGE PIT(Sl -SI r E flF�.�S�f�"�3i(Si. , � §� �; .: n . . �� 4, IN�iCAT�f��i��'N �:f��,�'E�?�P�C�!PL�T. ' `�`` ` . � � k�. ..3wA�_.Y ... .. ._j 5, liVC1I��lTL"-B�`..rT4-!ST?ce7S IF CC��lUi F�. . `" ``a `'``� .� Y �' _ ,. . - , �M _, , ., . .. _...�Y`4t - . .u... ._ ....id..i N ... . :%�(�,+. � 4' i . � .�, . .. ^� J . S ... . L l ,. ' .� ,. . J ..W '- J.,�. .. �. ,.n �Ye . - , ._a R" � �.... t• �s:."�`�. -�".�s. � . „�_�.,�_.�mv STo AL�.E°���'�Y� ,`. �._._ _ _._ __.. ,,;� FtELs���TE s _ .�.�»,m_.,,�..�.m..�._ - t .,-i , . . """'_""' �— .. . y, ....,- , . ,. . . ._. . �,.� � � . . . . _____ � r _ . . �,� --_._. _.�.».�._.._.__.>�__,_..._ _._._._.___.,.._....__�..__.��___. _ ,,,� � �._...�........�.....�...,......�.._...........�.. _.._._. _.e.. . . .r,� . . . ....r—� . � . . . , ��1. _. , o ... _ . _�_,._. �