HomeMy Public PortalAbout4950 AGNES AVE_Sewer_11/4/1953_house sewer connection to public sewer DEPARTIFZENT OF COUNTY ENGINEER SEWER-SEWAGE DBSPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX COUNTY ENGINEER I BUILDING 4-9.50 , / N ADDRESS /�
FOR APPLICANT TO FILL IN LOCALITY TC
BUILDIN
NEAREST
ADDRESS , CZ �` P ,s�i.Rzt / �� CROSS ST
LOCALITY"� F )y,a`>�� DISTRICT NO SERIAL NO PERMIT NO c
CROSS ST NEAREST uC}`.?Gl� j A 7•� J
OWNER
'yy� n RECEIVED BY Ready for Inspection DATE ISSUED
MAIL
T+lr'f��-�,�� � �2'�'p�j -/'I fr 1�
ADDRESS �� c� �) + n4, i/�' USE ZONE OCCUPANCY MAP
r � / BK PG
CITY
a 740
CONTRACTOR
mCO IMP NO
ADDRESS �4
y JOB NO
CITY TE&0
TRUNK PERMIT NO
STATE
REGIS RATIO60 NO �_7H COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO% STATE ENCROACHMENT
PERMIT. O
BLOCK TRACT 9P Y19INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT`d NOW ON I LOTS CHARGES
NO OF BLOG
USE OF
BUILDINGS L r-- '� CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE x
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE / \
PUBLIC SEWER @ $ 350 _ 4th RECEIPT NO DATE\II BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 / 1111
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED _\
WORK TO HOUSE SEWER 1 00
ALTER BR REPAIR EXISTING / NO I DATE I BY \
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS CESSPOOLODRYWELLIELD 200 STATION 114. 7-5 9 DEPTH Coy
SPECIAL CONDITIONS ONLY 200 n / MANHOLE REFERENCE
7 ISI (0 UPPER- LOWER
TYPE OF CONNECT N LENGTH FROM
OWNERS PERMIT $ 1 00 Y'-"" CURB t ML TO P L
AUTHORIZATION I TOTAL FEE Z 3r
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR S SIGNATURE DATE
SIGNED THIS DAY OF R��i`l+' 19 NEW HOUSE SEWER
OWNER OR 'jam Q CONNECT ADDITIONAL
OWNERS AGENT;/111 1�'6� �`_ rP Owi BUILDING OR WORK
ADDRESS' �_�U�f� � / �ii z SEPTIC TANK SEEP PIT(S)
�- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL C] DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM E LEGAL OWN ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESID AL PROPERTY a BACKFILL SEPTIC TANKS Fj
SIGNATURE
SEEP PIT(S)E] CESSPOOLS E)
C,�" .Sf a9o9
OF PERMITTEE �
76A642D 663 1/53