HomeMy Public PortalAbout6302 AGNES AVE_Sewer_4/13/1954_ DFPARTMENT OF COUNTY ENGINEER SEVER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX/ COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICAIJT T FILL IN LOCALITY
BUILDING NEAREST
ADDRESS q CROSSST
LOCALITY
0 STRICT NO SERIAL NO PERMIT NO
NEAREST A 23,P?z S
,J
CROSS ST
RECEIVED BReady for Inspection DATEISSUED
OWNER `1!113/7 y
MAIL � i�j / US/E20NE� OCCUPANCY BK MAP
ADDRESS PG
CITY TEL NO h (�Ol /� / I ll�n 's Z 7Z
CONTRACTOR Jfij�JA���� .�ivv� CO IMP NO
ADDRESS �d�1j/ J 1 �' S JOB NO
CITY TEL NO 10
69g/Coo Vol- TRUNK PERMIT NO
STATE
REGISTRATION NO 91P ( ® COUNTY
ROAD PERMIT NO
LEGALI � '� �js� STATE ENCROACHMENT
DESCRIPTION LOT NO ! PERMIT NO
d
BLOCKkt TRACT siaINDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF BLDGS CHARGE
USE OF
O x �- NOW ON LOT
BUILDINGS CONNECTION CHARGE FEES /Q
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO s
PUBLICSEWER @ $ 380 i� 5 4 RECEIPT NO DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR /EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO
ALTER OR REPAIR EXISTING 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 200 STATION '� DEPTH
CESSPOOL—DRYWELL ,
SPECIAL CONDITIONS ONLY 200 �3� MANHOLE REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
oYy CURBa LP L1 M L TO P L �j Q
OWNERS PERMIT s 1 00
AUTHORIZATION I TOTAL FEE �� �(.�
)la C-1644
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED e
HAVE
TO CONNECT THE ABOVE DESCRIBE EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
r ' r /.
SIGNED THIS _/ DAY OF _ 19 NEW HOUSE SEWER Sa r)& �1S-
OWNER
w"L' v CONNECT ADDITIONAL
OR
OWNERS AGENT - - - - - - - BUILDING OR WORK SEPTICTANK SEEP PIT(S)
ADDRESS _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THA-11 HAVE READ THIS APPLI 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 THAT IAM 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 RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS E
e SEEP PIT(S)E] CESSPOOLS[p- SC trD 61 n/`
SIGNATURE
OF PERMITTEE
76A642A 663 7/a3