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Home My WebLink About1091A (5) , w , ,.,,. . ..,.',: ... w.- ..:; �< .K .;. .�u. , <,: . M. ,..,, �_ 76A642D � . . . . .Y^;. ��X�,-,:,yit7,�r�,� ��;,8� t�.„.' . .. , .. . .. .. ..�� CEBOBIREV.6/781 � ��,�A/�� ., ,.. , os AP��IGAT��N F�"�} ��►� _ _. . � �. . _.. sat.:.� . :..� „�, ;; � � , _ .� , .._. .. .. . S�WER - S�WAC�E C►6��tJ ' COUNTY O�lOS A!V(�ELES �IJILp1�IG AO+IA SAFETY � . . � P�./RAPpLICA�NTTV FILLIN � - � DISTRICT;NO. GRO'P f'::MAP '� _,�PROCESSEDBY � - - . .... ..,.g B�K PG�. - , .-.�.. .,: ADDRESS r w_��._ � � . �� ✓ �. d„� � ... '� - �'�- � ��+ �, ��., TT� � =�.� CONNE�710N . ATA !-OCALITY � . - � NEARE$T . . STATIQN � �� DEhTH� ... . ��. . . GROSS ST. �- �� " , , . ) � . /�^ ,�) MANHOLE REFERENGE .,�,-^/�� L PPEF�.. OWNER ,�� e�� . °p � /I.� . � 0..».qJ � . . � � TYPEOFGONNECT(ON�� LENGTFit�'R'OM �� ADDRESS �� i �,.� ��r / f��p �j� y Y. GURB .L. M L.TO P.L. ^ G� �..G�'�YL.La.� S:.� ."� , . — P.C.�NQ r . . .. . GITV TEL.NO. � � �"`� „�✓��,� Gq.IMP.NO. � �Jt76 tVO. ��q,� LEGAL �f � TRUNKPERMITNPJ. ROADPERMITNp. LlESCRIPTION LOTiVO. - � AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE BLOGK TRACT � "'� ?a"� NO,bF 6LpG8.� � � � � SIZE OF�OT NOW ON LOT HWY.OR ST.WIPENING USE OF . � STATE£NCR4ACHMEN7 � � � � � ' � - BUILDINGS PERMIY NO. > .p CONTRACTOR �'�, C.g.. ��' ,,, . INPl�STRIAL ' WASTE APPROVAL ApDRE55 �/ ,�s .�,,,Yy.t{"3!. /_�i') (��i GHARGES� � - � � CITY ,,'(��i�.. „�,e 7EL.NO. �?� -^�� 0 (p "�� aNNECTION CliARGE FEE STATE a�'J ' LIG. f$ REIMBURSEMHNT FEE '�' LICENSE NO. ,J.z.j' ��... `3 . GIA55 i...,.^�� . � . . . _ - Q` Np. DESGRIPTIQN OF WQRK FEE �P��aO��S, ATE -I ��P�CTOR'S SI ATURE (� HOU$E�SEWERCONNECTINGTC! � �3 � . � � PUBI.IG SEWER � � 6` SEPTICTANK,5EEPAGE PR OR �- �-�,� � . -- NEW HqVSE SEWER * .. PITS ANp/OR CSRAINFIELD � CONNEGT ADfJITIpNAL � HOUSE SEWE CONNECTING TO BUIi.DIMG pR WORK PRIVAYE DISPOSAL SYSTEM GONNECTADp1710NALBLDG:�OR �- -�� . SEPTiCTANK.SEfiP.PIT(SI � WORKTO�HqV5E5E1NER.... .. ._ ...,.„.,_,....., . . . AN�/Ot?DRAWFIELO . . .._... OVEFFLqW SE'EPAGE PIT,DRAINFIELD GESSP04L EXTN.,CESSP60�,DRYWELL.MANHOLE ❑ L�RYWELL❑ . ALTER.REPAIROR ABANDON HOU$E A�TER.REPAIR,SfiW6R OR SEWE�ORDISPOSAL5VSTEM � � SEWAGEDISPOSAL_$YSTEM . . .. � ..,. .. .. . ,_ . .. ... ..: ....._ ... ,.. DISCQNMEGT PLUG ANp.. �. .... .. .. . .,,.,,..,.. ABANPON HOUSE SEWEF3 � ........ ..... ....... '. . .,...... .,..,.. . ,.... ..... . BAGPCFII.L 9EPTIGYANKS❑ . ,_..... . . - .. . . seEP.a�iris>❑ cEssaoo�s❑ pyyy��$ C'ermit s ��'1 AUTH(y�RIZATIfJIV TOTAL F�E ;' ` ,�� ` VACIDATIfJN � _` I HAVE AT THIS OATE A CQNTRACT WITH 7HE HEREIN.N/tiMEO�CON- . . . . � ... .: ( $.J�7, .�{ � . �� TRACTOR TQ CONNECT THE ABOVE DESCR�HED�EXISTING DWF.LLING � TOTHEPUBLICSEW . - `} � � � SIGNEDTHIS .... :. � DAYQF��'!a)'�,^�,,d 19Y�t'� .. .. . .., 3'2 � s� � '0+ � � . � , .... ,.., . �.�_.,. �,,, �4 ..,..,. OWNERS ACaENT Y �6,�__gF L��.�.:iC3'.�{r_''.'�°� . .. . , . .. }...� �y ° 4a;{'�r . , .. .. . �.. , ... .. ... , .. . .. . . ADORESS . '� '� . . . . . . . , �.,� @ H9 � {2.`Y iJ �. ,.,. I HEREBY ACKNOWLEGGE THAT I HAVE REAO T'H15-APPLICATION �� - ��" � �� AND STATE THAT THE ABOVE IS CORREC'C AND AGREE TO CC7MPLY ��p� �� g C,!•-••`4� (';;. � WrTH ALL GOUNTY ORDINANCES AND S7ATE L.AWS REGULAT�NG ' � � � PLUMBING�ANDSEWERS. _..... , . ... ., .. ,.... ... _.... . . . .�. ............... .......... ... .. ...... .. 1 HEREBV CERTIFV THAT I AM PROPERLV REGIS7ERED AND/OR LICENSED AS RE�UIRED BY��SS ANG�LES COUNTY AND$TR7E OF CALIFORNIA QR TF{AT I AM THE.LEG.4L OWNER OF,AND 1NTENPTO RE- SIDE IN,TFiEF,BOVE DESCRIBED RESIDENTk1,L�pR6PERTV, � -� � � � - � � � - - � - f" ' � �� f SIGNATURE 4 ��- . �- � � . . , �S a J� .. . ........ . ........:. ......._, ..,., . .........,. ........,�.:..,,..... OF PE RM ITTE E �d.��Y°^r✓ � ..,..,.r . . 3.,,. .... ..;;.� .:.. . ...; .:._ , _ ;, ..',; �. ..:... - ... ., , , ..,. , , � . , . ,i F�R��R'ri4�E1VT I�SE RE��3i��l�B�ORMATd�N' � '. '� . � .. ,� '� .. � �� o��.��,�;� ° �� ', ��r`" '�� E a.;�' sf�.�'�° �y.�-:. 1. iiVDICATE ALL BU?LDINGS ON Pl20PERTY. . ::, � , � :;::, �.i ...-, . ,.:; . ... ., ,w3�r-: � -. = �� .}:, oro � ;,� x�.�w'..c,�.<m,,�.Hu..,._srA�.�� .:� 2. IND!C,4T� AND UIMENSION>SEV�JAGE DISPOSAt ''` • , , , ,�.k r. ,,� �� ,;, ` ° `� BUILDII�lGS ,. ` , ,. -, _ , t .� , . , r: , :,:��. ° . _ � ,� . . ,., � v P WlTH TIE �fSTA9�l�ES �'C) AND PROPERI'1'LINE5. ;..,, ��. .. ; 3. {�dDiCATE SIZE OF SEPTiC TAt�lK-DEL' ` ,� � PT�—i O� SEEP.. . . :° AGE PITiSI -SIZE OF CESSPrJC?LfSi: ' ,; ' ,.,,;. ,. �. INDICATE NORTFi DlRECTION ON PLC3T. . ::_...�� ` �. �:_ � �. . , ... ...._ .. , c S. 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