HomeMy Public PortalAbout4940 AGNES AVE_Sewer_6/13/1955 s � �
o
7GA642DAPPLICATION FOR PERMIT 7
66
IS&EE 663 12 54 PERMIT 1
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
r County of Los Angeles BUILDING _�
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING L7
OCAL
FOR APPLICANT TO FILL IN
fITY
ST
ST
LEGAL �SngpLy Z66
DESCRIPTION LOT NO "ted BLOCK �pTRACT �( 4SS 0
SIZE OF LOT rg) N � NOWOONLOTUSE OFpS�_7 �A `'A/A CAL TEL NO -29
BUILDINGS.. ,L1 Ii✓ //4I Q pr- lir/ � DISTRICT NO GROUPMAP
BK PG
CONTRACTOR 5-5-- S(J.'R Al 14 /'- 76
ADDRESS Z19 7 _y CONNECTION DATA
CITY TEL NO �"�Za STATION �0;�-6 7 DEPTH
440 IL ❑ STATE �� e9 OA MANHOLE REFERENCE
REGISTRATION NO ❑ COUNTY , UPPER MWER
TYPE U�.O N ECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE rte` FCURBJ 1.11,12- M L TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXIaTING p6/
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
DINNERS PERMIT $ 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVERTHISCDAT ECO TRACTEDEWDESCR BED EXITH THE REIN NASTINGME
ELLONG APPROVALS DATE INS ECTOR S SIGNATURE
TO THE PUBLIC SEWER ---/yy//���//SIGNED THIS X49 DAY 04M& 192J J NEW HOUSE SEWER
OWNER OR rFJ/C CONNECT ADDITIONAL
OWNERS //AGEVT "�/�/���0c^�/-t -&f & BUILDING OR WORK
ADDRESS/630 tU /-�7�_)i GA9Det"`eA6.�F^ SEPTIC TANK SEEP PIT(S)
AND/OR DRAIhFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[3DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS I SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 A THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PR ERTY BACKFILL SEPTIC TANKS❑ 1
SEEP PITS) Cl CESSPOOLS
SIGNATURE
OF PERMITTEE
WILLIAM J FOX COUNTY ENGINEER VALIDATION
AC04599S M13 4 7.5 0 In
BY BY
DEPUTY DEPUTY
BY BY
�® ¢ DEPUTY T DEPUTY