HomeMy Public PortalAbout4932 AGNES AVE_Sewer_8/30/1965_ DEPARTMENT OF COUNTY ENGINEER I SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER BUILDING
ADDRESS �.� "� L�Vg )O�N C5 n to
FOR APPLICANT TO FILL IN LOCALITY
AD
ADORPG NEAREST
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LOCALITY DISTRICT NO SERIAL NO PERMIT NO
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NEAREST V A I G S la 8-
CROSS ST
RECEIVED BY Ready for InspectionDAT ISSUE
OWNER ' Q/2-
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MAIL m,-yUSE ZONE I OCCUPANCY MAP
ADDRESa q BK PG
CITY TEL NO ,(� — IITT rz::_ I G
CONTRACTOR, CO IMP NO t
ADDRESS ` Ll 41
JOB NO -------
CITY B TEL N TRUNK PERMIT NOow—,A STATE
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REGISTRATION NO ( ® COUNTY ROAD PERMIT NOLEGAL
2
DESCRIPTION LOT NO /; C'b D STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT INDUSTRIAL asp`
WASTE APPROVAL
SIZE OF LOT ` � �� )NOW
OF BLDGS
NOW ON LOT CHARGES
USE OFj
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BUILDINGS CONNECTI HARGE FEE �r
(A� ¢+� ,y
NO DESCRIPTION OF WORK IFEE
HOUSE SEWER CONNECTING TO C //�� REIMBURSEMENT FEE--�,
PUBLICSEWER 0 $ 350 RECEIPT NO DATE I BY
HOUSE SEWER CONNECTING TO \
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO DATE I BY\_
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM_ 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATION ���/� �� DEPTH
CESSPOOL—DRYW ELL `
SPECIAL CONDITIONS ONLY 200 V�� Vg/ Q ��ANH REFERENCE LOWE
TYPE/OF CTION LENGTH FROM
OWNERS PERMIT I ZY CURD \ -__FM L TO P L
AUTHORIZATION I TOTAL FEE I �}CS
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS �LV DAY OF NEW HOUSE SEWER'
OWNER ORCOFINECT ADDITIONAL
/
OWNERS AGENT BUILDING OR WORK
/ �_ y`�
11 SEPTIC TANK SEEP PIT(S)
ADDRESS Y:5 `� _ AND/OR DRAINFIELD
CAITHEREBY ACKNOWLEDGE THAT KHAVE READ THIS APPLI CESSPOOL[:] DRYWELL
ION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULAT NG PLUMBING AND SEWERS SEWAGE DISPOSAL,SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN
ER OF THE ABOVE DES IBED RESIDENTIAL P OPERTY BACKFILL SEPTIC TANKS E]
SIGNATURE SEEP PIT(S)[:] CESSPOOLS
OF PERMITTEE
76A642D 663 1/53 ' �f