HomeMy Public PortalAbout5921 AGNES AVE_Sewer_1/8/1953_ I
DEPAItI ENT OF COUNTY ENGINEER , SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES I BUILDING ` ,h ���
WILLIAM J FOX, COUNTY ENDINEER ADDRESS `�C( 1�1 Ave
FOR APPLICANT TO FILL IN LOCALITT__� ` I
BUILDINGNEAREST
ADDRESS S ✓e CROSS ST
LOCALITY A2 ?tK/ DISTRICT NO SERIAL NO PERMIT NO
NEAREST / 1` r A 19 G-4 O S
CROSS ST !� S s j
�EIVED BY Ready for Inspection DATE ISSUED
OWNER cl-CL-i � I C -S ?
MAIL �Q_ C USE ZONFJ OCCUPANCY BK MCA7P PG
ADDRES 41&
CITY - TEL x736 S-
CONTRACT R I_�>Q G _ C
CO IMP NO
ADDRESS
JOB NO -�-�
CITY (( TEL N TRUNK PERMIT NO
REGISTRATION NO J� ZSTATE
B COUNTY
ROAD PERMIT NO 41� SS
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT S6! INDUSTRIALWASTAPPROVAL —_
SIZE OF LOT v' 1p.0 NOW ON LOT0 OFS CHARGES
USE OF
BUILDINGS CONNEC HARGE FEE
NO DESCRIPTION WORK __F&V REIMBURSEMENT FE
HOUSE SEWER CONNEWING TO
PUBLIC SEWER 0 $ 350 RECEIPT NO I I BY
HOUSE SEWER CONNECTING TO J
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 O NO I DATE BY
ALTER OR REPAIR EXISTING
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—DRYWELL
SPECIAL CONDITIONS ONLY 200 I NHOLE REFERENCE
Sp O <UPPERj LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I 00 1 �qM_ 'Vk MIL TO P L
AUTHORIZATION TOTAL FEE 6-C
1 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 J
SIGNED THIS DAY OF 194 J NEW HOUSE SEWER
OWNER e'R CONNECT ADDITIONAL Y
QW r" AGENT _ _ _ _ _u BUILDING OR WORK �
ADDRESS L !�[t /�.� SEPTIC TANKSEEP PIT(S)
y AND/ORD RA I NFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE AD THIS A LI i CESSPOOL❑ DRYWELL
CA
TIONAND 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 THATRE AM PROPERLY REGISTERED) DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THA THE LEGA OWN
ER OF THE-ABOVE DESCRIBE ENTIAL PROPE I BACKFILL SEPTIC TANKS
SIGNATURE TS :5'e-_4 I SEEP PIS)[] CESSPOOL /5G ��� ,�4
OF PERMITTEE _ Ir 4
16A642A 663 7/53