HomeMy Public PortalAbout5550 ALESSANDRO AVE_Sewer__ - DEPAR1MENT OF COUNTY SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER I ADORE S'5 ' t—,,S
S 2_`Y
ADDRESS �`{{// J J 7
FOR APPLICANT TO FILL IN LOCALITY 7�,
BUILDI �J NEAREST
AUIL 'G �/�y~C/ S,� 'J y� YC�Ja ,i..,r/tf rEROSS ST G(�
LOCALITY !� DISTRICT NO SERIAL NO 4ERMIT NOc
NEAREST A .J?,0� /�J J
CROSS ST ,� ,._�
RECEIVED BY Ready for Inspection DATE ISSUED
Am
OWNERAF `L
MAILUS Z0N OCCUPANCY MAP
ADDRESS G O / �V L i� - BI( PG
CITY TEL NO G�- /a
CONTRACTOR 64-4,dj, 0-f CO IMP NO
ADDRESS e_Aj '
�'�J"`Q JOB NO
CITY A TEL NO `/JD TRUNK PERMIT NO
STATE
REGISTRATION NO �� c'- Zd® COUNTY ROAD PERMIT NO / Ci �CO
LEGAL % STATE ENCROACHMENT
DESCRIPTION LOT NO /"' PERMIT NO
BLOCK TRACT SS (�/f/ INDUSTRIAL
41 WASTE APPROVAL
NO OF BLDGS ,/
SIZE OF LOT 6 NOW ON LOT �� S CHARGES
USE OF
BUILDINGS .�+� CONNECTI CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �ry /'
REIMBURSEMENT
PUBLIC SEWER @ $ 350 J C� RECEIPT NOTE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION REC ED
WORK TO HOUSE SEWER 1 00
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 200 STATION = � DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 200 'V<�v f a�MANHO R�FERENCE LO ER
TYP TION' LENGTH FROM
OWNERS PERMIT ; Y ' CUPB P L M L TO P L �O
AUTHORIZATION TOTAL FEE
I RE
HAVE THIS DATE CONTRACTED WITH THE HEIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _ D Y OF _ Iq t NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT - - BUILDING OR WORK
ADDRESS IAND/ORDRAINFIELO IT(S)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL❑ DRYWELL
CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALI COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
IHEREBY 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
L ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SEEP PIT(S)I-] CESSPOOLS
SIGNATURE /
OF PERMITTEE CS-
76A642A 663 7/53