HomeMy Public PortalAbout5720 ALESSANDRO AVE_Sewer__ DEPARTMENT OF COTTNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
fCOTTNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS 72
FOR APPLICANT TO FILL IN LOCALITY L/
F,� 7
BUILDING / / NEAREST
ADDRESS S J 2 �t�G-(,�..,.�. �t,. CROSS ST.
LOCALITY /. ;(ry e--> DISTRICT NO. SERIAL NO. / PERMIT NO.
NEAREST A
CROSS ST.
t I � RECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
,}/S
ADDRESS � ��'V t� '�-�""�'r� USE ZONE' OCCUPANCY MAP
BK PG
CITYt. L�ti G', , TEL.NO. -444- / 2.,yf- � ?�
CONTRACTOR 6
CO.IMP.NO. Z.3 57
ADDRESS S G� '-t'` JOB.N0. -
�r— r
CITY � �►� �, TEL.N6.�� �✓�J TATE
TRUNK PERMIT NO.. 'l
REGISTRATION NO. f] COUNTY ROAD PERMIT NO. 3,3
LEGAL ,� /—- {
DESCRIPTION LOT NO.// � '! STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT �,.;��, INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT�-V 1\ NO.OF BLDGS.
NOW ON LOT r CHARGES'
USE OFf�••
BUILDINGS �,t.a� �"'Y CONNECTION CHARGE F E
NO. DESCRIPTION OF ORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTIN TO
PUBLIC SEWER Q $ 3.50 I RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PR;VATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.ORE EPTION R ORDED
WORK TO HOUSE SEWER 1.00 NO
ALTER :OR REPAIR EXISTING 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
PITS AND/OR DRAINFIELI) 2.00 I STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I / C+ MANHOLE REFERENCE l �.J UPPER `.R ,-" /, QTR
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I I Y. CCPRB P.L. M.L.TO P.L. r'
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREINNAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-.... . .....DAY OF....„....
- -4. 19�fj NEW HOUSE SEWER
OWNER OR r - CONNECT ADDITIONAL
OWNERS AGENT-... '..\_ .._....- ....
BUILDING OR WORK
r °� SEPTIC TANK,SEEP.PIT(S)
ADDRESS/�'..T - 1.i�k.-..._�J �.. ?>'` s. �� r AND/ORDRAINFIELD
CAITHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL
ION 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/ LICENSED AS REQUIRED LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT AT I AM THE LEGAL OWN-
ER OF THE ABOVE DESGRIBEQ-BLUPENTt4L PROPERTY. BACKFILL SEPTIC TANKS E]
LFOI
NATURE
SEEP.PIT(S)� CESSPOOLSO Cr"
PERMITTEE. _-
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