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HomeMy Public PortalAbout5957 AGNES AVE_Sewer_1/28/1954_ DEPARTMENT OF COUNTY ENGJNEER T SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES IADDRESS WILLIAM J. FOX, COUNTY ENGINEER Q UILDING FORBUILDING APPLICANT C APPLICANT TO FILL IN LOCALITY ADDRESS / ^ CROSSST. LOCALITY c DISTRICT NO. A A SERIAL NO. 19 PERMIT NO. e NEAREST 9_�SIR—S CROSS ST. RECEIVED BY. Ready for Inspection DATE ISSUED - OWNER ADDRESS MAIL USE ZONE OCCUPANCY MAP BK PG CITY r-- TELAO. --R-.., I = CONTRACTOR ` CO.IMP.NO. I C ADDRESS tl'l 04 AW JOB.N0. CITY TELAO. 4 ` 31 TRUNK PERMIT NO. REGISTRATION NO. / r32- 491 REGISTRATION '3J� 2 4 COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT N0. / STATE ENCROACHMENT (e ` PERMIT NO. BLOCK TRACT ( WASTEAPPROVAL .� SIZE OF LOT A f NO.OFBLDGS. NOW N LOT CHARGES USE OF BUILDINGSdz_iza�� CONNECTI N ARGE FEE NO. DESCRI 1 N OF WOF4K FEE REIMBURSEMENT FSE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3.50 5O 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 - N0. ALTER OR REPAIR EXISTING I DATE 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 2.00 STATION 5 4 8-1 DEPTH - Q I CESSPOOL—DRYWELL SPECIAL CONDITIONS-ONLY 2.001 MANHOLE_REFERENCE Spy .p UPPER ROWS TYPE OF CONNECTION—� LENGTH FROM / OWNERS PERMIT Y� Curtsy cry'. M.L. P.L. 1 00 AUTHORIZATION TOTAL FEE I 4 O - 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....LO........D YO ...... .Iq NEW HOUSE SEWER Sr - OWNER OR CONNECT ADDITIONAL OWNERS AGENT.--........ BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS---------------� •-.-...._.........._......_......_......_.........._.._......_. AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL 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 ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVEBED RESIDENTIALPROPERTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S)� CESSPOOLS 5G �G� <' Re- OF PERMITTEE - - --•----------•---...........------------------- 76A642A 663 7/53 V ©r /�r