HomeMy Public PortalAbout5522 ALESSANDRO AVE_Sewer__ DEPARTME VT OF COUNTY ENGINEER
SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY 1
PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENOtNEER I ADD"UILIRE
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FOR APPLICANT TO FILL IN LOCALITY -7
BUILDNG NEAREST
ADDREISS � i /�S� .�+/ /�(� CROSS ST �Yd<> Q !ir✓c/ v
LOCALITY Cr , DISTRICT NO I Ready for Inspection PERMIT NO
NEAREST ,
CROSS ST '�7(j "+
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RECEIVED BY DATE ISSUED)Y DATE
OWNER l�E'jco, /v�
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ADDRESS _;1-3cMAILF /-s(Z�A� wUSE ZONE OCCUPANCY BK MAP PG
CITY TEL NO -6 � I ke"o � /3 2
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CONTRACTOR (cr�/1 _ iS a aA_I.by 1 HCO IMP NO / w 2
ADDRESS 7 /.I �+ � +' /ti JOB NO
CITY ��/r"� TELL�NO_�F('./ �A '�6( TRUNK PERMIT NOATE
REGISTRATION NO tY .2 � ��
/ �t�t �1�p *►y ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO �ir '/�t_'/ / htlr/ 'i
STATE ENCROACHMENT
—I— PERMIT NO +
BLOCK TRACT �f{- /'J � J INDUSTRIAL ^'
WASTE APPROVAL
SIZE OF LOT (t/_ �( NOW ON LOTS CHARGESUSEOF
BUILDINGS _k E� 0�T CONNECTION.HARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ) REIMBURSEMENT FEES
PUBLIC SEWER @ $ 350 RECEIPT NO _--DAT BY
I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED�O'�
_ WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO ( 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 24 (7 '7
9 DEPTH ,
— DRYWELL
SPECIAL
CO
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
UPPER6 (LOWER
TYPE OF CONNECTION' LENGTH FROM
OWNERS PERMIT $ 1 Y CURB VP L ML TO P L
AUTHORIZATION I TOTAL FEE v
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING, APPROVALS INSPECTQRSSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF Iq, NEW HOUSE SEWER b�N _ 11 �3 �,4
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT �(� (� _ BUILDING OR WORK
ADDRESS ilF ��_-_ SEPTIC TANK SEEP
AND/OR DRAINFIELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL E] 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
1 HEREBY CERTIFY THAT I AM JPRPPERLY RE STERED
AND/OR LICENSED AS REQUIRED S ANGEL OU DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR T T AM THE 6 OWN ABANDON HOUSE SEWER
ER OF THEABOVE DESCRIBED SI NTIAL P P TY BACKFILL SEPTIC TANKS .`
SIGNATURE
SEEP PIT(S)E] CESSPOOLS
Ate.. 1
OF PERMITTE _ _ _ - - _—
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