HomeMy Public PortalAbout5807 AGNES AVE_Sewer_4/7/1954_ DEPARTMENT OF COUNTY ENGINEER SEINER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J FOX, CDUNTY EEN13INEER I ADDRESS J�- 1r� AQ {pro-, Pkv�
FOR APPLL TO FILL IN LOCALITY DC7 ,
BUILDING,53—o NEAREST
ADDRESS S(J Q CROSS ST ("
LOCALITYDISTRICT NO SERIAL NO PERMIT NO
NEAREST v A OC3 "�'��_
CROSS ST
RECEIVED BY Ready for Inspection DATEISSUED
OWNER Haeric-'r —� V •
MAIL BK�� A� � USE ZONE OCCUPANCY MAP
PG
ADDRESS Cir.j/J/
CITY -TEL NO
CONTRACTOR
CO IMP NO �P
ADDRESS P,01 13,
� JOB NO
CITY TEL NOI�A a,SQ cc' TRUNK PERMIT NO
STATE ,r�
REGISTRATION NO3 COUNTY ROAD PERMIT NO Q
LEGALN���, / Ian` CS1 O
DESCRIPTION LOT NO L STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT -MSG I INDUSTRIAL P--
WASTE APPROVAL
SIZE OF LOT O NOW ON LOTS CHARGES
USE OF
BUILDINGS CONN ECTIO ARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 350 3 S O RECEIPT NO I E 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 10
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR I
PITS AND/OR DRAINFIELD 2 00 STATION 1-� �� ,� DEPTH C
CESSPOOL—DRYWELL 4—
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
LOW
_ TYPE OF�G CTION LENGTH FROM
OWNERS PERMIT $ 1 00 C C_UR= ML TO P L 3
AUTHORIZATION I TOTAL FEE 1# 150
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 DAY OF % n 19 _ NEW HOUSE SEWER 5'G YdGrC �-Wil'
OWNER OR / CONNECT ADDITIONAL
OWNERS AGE T JJ =dL BUILDINGORWORK
ADDRESS / SEPTICTANK SEEP PITS)
� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDVlHrABOVE
T I HAVE READ THIS APPLI CESSPOOL E] DRYWELL
CATIGN AND STATE THAT IS CORRECT AND AGREE
TO COMPLY WITH ALL CODINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDAND
ON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
EWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS El w� G
SIGNATURE / }� SEEPPIT(8)E] CESSPOOLS[ SG SBU~ ¢�!—L
OF PERMITTEE
76A642A 663 7/53 pa '/ 4-k0�AV