HomeMy Public PortalAbout5554 ALESSANDRO AVE_Sewer__ DEPARTENT OF OOUNTS ENGDT= SEWER—SEWAGE DISPOSAL _ 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COU= OF LOS "GEl"
BUILDING
WILLIAM J FOX, COUNTY ENalmiimm I ADDRESS
FOR APPLICANT Tp FILL IN LOCALITY
ADDRESS t�.�/td— � t CROSS ST v
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LOCALITY DISTRICT NO Ready for Inspootion CPERMIT NO c
NEAREST c.+ 141,1316 J
CROSS ST Q RECEIVED BY DATE I IS UE BY DATE
OWNER
MAILUSE ZONE OCCUPANCY MAP--
ADDRESS —/
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BK PG
CITY TEL NO / Q 9 ' -,+'1
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CONTRACTO CLA C6 CO IMP NO / n
ADDRESS A r
JOB NO
CITY �+. TEL NO
TRUNK PERMIT NO
REGISTRATION NO STATTY
LEGAL / , n ROAD PERMIT NO '� 96 O`4—r
DESCRIPTION LOT NO 00 , 4J9 (���//„2�q�'� If STATE ENCROACHMENT
�--e PERMIT NO
—Auw- —LO-"TRACT � , � � WASTE APPROVAL
SIZE OF LOT J( �`� NO NOW ON LOTCHAGESS
USE OF
BUILDINGS , CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER ® $ 350 RECEIPT NOI DATE BY
HOUSES EWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXC TION RECORD D
WORK TO HOUSE SEWER 1 00 \
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00STATION DEPTH /D
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
Y
CURB PL ML TO OWNERS PERMIT S 1 -6sa 1
AUTHORIZATION TOTAL FEE -
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE LIC SEWE APPROVALS INSPECTOR 8SIGNATURE DATE
`
SIGNED THIS__ DAY NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS A f� _ BUILDING OR WORK
ADORES � SEPTIC TANK SEEP PITS)
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE ��� �--�� SEEP PIT(S)[] CESSPOOLS
OF PERMITTEE � � `�+
76A642D S&E 663 4/54