HomeMy Public PortalAbout4919 AGNES AVE_Sewer_3/14/1955_house sewer connection to public sewer ®p��q Ips', pp�� {per g��q PERMIT pp..�(���ypg 7 4'
15&E46631254 A • LICATIOW ®0 ■ ■ E ■ MIT I 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of Coun+y Engmeer
'r County of Los Angeles ADDRESSG�✓�
WM J FOX COUNTY ENGINEER (}
CASSATT D GRIFFIN SUP T OF BUILDINGMMOMM LOCAL(Y t �H t-
1 1�
FOR APPLICANT TO FILL IN NEAREST
caoss sr\r
LEGAL
DESCRIPTION LOT NO OWNER ( '
BLOCK± TRACT' 3 MAIL .�f A
ADDRESS 1
NO OF BLDGS / +�
SIZE OF LOT NOW ON LOT / CITY NO {
USE OF V
BUILDINGS ,/� �
DISTRICT NO I GROUP _ I P
BK PG
CONTRACTOR �L/'% -��-r � S_ /— — 7�
ADDRESS .rj/ /1 S� Al � CONNECTION DATA
A � r
CITY L._. q- TEL NO —10 (IP 4� 6'1&"- STATIIOON� 7-74-?0� DEPTH
STATEMANHOLE
REFERENCE
REGISTRATION NO �'j 6 [I COUNTY �/ �� UPPER
TYPE OF CONNECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE Yr CURB -RrL— M L TO P L d�
SHOUSE SEWER CONNECTING TO g ti
PUBLIC SEWER Q $ 3 50 f>
HOUSE SEWER CONNECTING TO
_ rPRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR 'ICO IMP NO ^� 34,S—JOB NO i
WORK TO HOUSE SEWER 1 00 1
ALTER OR REPAIR EXISTING TRUNK PERMIT NO ROAD PERMIT NO �9
SEWER OR DISAOSAL SYSTEM 1 00 _ V
(DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT '
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANI SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL IWASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 1 CHARGES y
CONNECTION CHARGE FEE
OWNER S PERMIT $ 1 00
AUTHORIZATION TOTAL-FEE �� REIMBURSEMENT FEE
TRACTORHAVE T TO CONHIS NEECT THECONTAABOVE DESCRIBED BED EXICTED WITH THE STINGNAMED
DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO ThE PUBLIC SEWER Iy/�/Q/�/
SIGNED THI§l DAY OF_%VT� 19 (NEW HOUSE SEWER 3 t5IS5 eS c��
OWNER OR \ �I }CONNECT ADDITIONAL
AORK
OWNERS 6AGENT LA- tBUILDING OR SEEP
J�1SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
,F I hEREBY ACKNOWLEDGE T AT 1 HAVE READ THIS APPLICATION CESSPOOL[3DR_YWELL[3AND 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 '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 I AM THE LEGAL OWNER OF-THE-ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
- SFEP PITS ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
WILLIAM J FOX COUNTY ENGINEER VALIDATION
�I =_ 1 5-6 1" MAR 1 450 °f
'4 4
BYsr BY y
DEPUTY _ DEPUTY
'BY BY
P(v® DEPUTY DEPUTY