HomeMy Public PortalAbout6018 AGNES AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY EN13INEER BUILDING
ADDRESS
FOR APP CANT-ATO FILL I LOCALITY
BUILDING �� ` L r CROSS ST
NEAR EST
ADDRESS / rr+l
LOCALITY , DISTRICT NO SERIAL NO PERMIT NO C
CNEAREST ROSS ST L / ( A 23 P'7/ S
RECEIVED BY �, Ready for Inspection DATE/ISSUED
OWNER R
ZATY
MAIL USE ZONEN/ OCCUPANCY MAP
ADDRESS ✓ 61 BK PG
CITY ` EL NO 1 L)
CONTRACTOR
CO IMP NO
ADDRESS ��J l /� J )OB NO
CITY �(.� A, �/eTEL NO 4/erd P"
TRUNK PERMIT NO
STATE -7
REGISTRATION NO 3 8 COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO TE ENCROACHMENT
MIT NO
BLOCK TRACT �� / 0 i INDUSTRIAL
J WASTE APPROVAL
SIZE OF LOT ` �e < > /� NO OF BL 1
i NOW ON LOTT CHARGES /
USE OF
BUILDINGS ' CONNECTION CHAR`G IFEE
NO DIESCIRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 RECEIPT NO DATE I BY
HOUSESEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR /EXCEPTION ECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING / NO I 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 t �
PITS AND/OR DRAINFIELD 200 STATION �SV t DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITCJNS ONLY 20000
00 MANHOLE EFERENCE
'y -A _� rUPPERS LOWER
TYPE QF—CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 ,+ cu B- -�L- M L TO P L .S—
AUTHORIZATION TOTAL FEE Z/ 6-0
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDI
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER `L
SIGNED THIS !L�_ _ DAY OF G _ 19J 1 1 NEW HOUSE SEWER
OWNER OR ``YYjj J CONNECT ADDITIONAL
OWNERS AGENT _q, _ _ BUILDING OR WORK
V I SEPTIC TANK SEEP PIT(S)
ADDRESS LL t V4 _ - AND/ORDRAINFIELD
1 HEREBY ACKNOWL DGE THAT 1 HAVE RE THIS APP CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGR E
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 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 ABOVE DESCRIBED RESIDEN3IAL PROPERTY BACKFILL SEPTIC TANKS
SINATURE SEEP PIT(S)[] CESSPOOLS
G
OF PERMITTEE
76A642A 663 7/53 �� /