Loading...
HomeMy Public PortalAbout5931 ALESSANDRO AVE_Sewer__ I 16 a}E 663 12 54 APPLICATION FOR PERMIT ■ DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D S S P®SAL Deportment of County Engineer County of LOB Angeles AUILDINGDDRESSJ L , A'0-6 WM J FOX COUNTY ENGINEER _ CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILLLEGAL IN cRISI IT DESCRIPTION LOT NO, �Z , / ° �^ OWNER �G� ) BLOCK TRACT &S ADDRESS C / / SIZE OF LOT NOW I NO OON.LOTS CITY 07 7 C TEL NO USE OF BUILDINGS ,° DISTRICT NO I GROUP I BK PG MAP CONTRACTOR i2H/VG7 /C ©���� �jI 4 `� / ADDRESS //�� CONNECTION DATA �j— CITY vs- 1� TEL N047- 4"-y 2- 6 6 STATION 'i e V DEPTH ( / ry 1 (� KI,—STATEC ANHOLE REFERENCE REGISTRATION NO / .S �JrJ ❑ COUNTY 121)[X,G ".-1 02 UPPER R TYPE NE ION LENGTH FROM / NO DESCRIPTION OF WORK FEE Y CURB I P L M L TO PI HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $_3 50 HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO WORK TO HOUSE SEWER 1 00 / ALTER OR REPAIR EXISTING EWEP OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO��,� S DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT �— AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SE-TIC TANK SEEPAGE PIT OR _ PITS SND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 ARLES CONNECTION CHARGE FEE OWNERS PERMIT $ t 00 AUTHORIZATION TOTAL FEE 5-0 REIMBURSEMENT FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE TO THE PUBLIC SIGNED THIS DAY OF 19s� NEW HOUSE SEWER OWNER OR '',',, ',��� CONNECT ADDITIONAL -� OWNERS AGENT�Re�T, /� BUILDING OR WORK ` SEPTIC TANK SEEP PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL C3DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SENERS SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED R IDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ SEEP PIT(S) ❑ CESSPOOLSDd. IJ 2b .I1/AB1'. l SIGNATURE OF PERMI EE ✓G7-�✓� WILLIAM J FOX COUNTY ENGINEER VALIDATION 2683 APR 18 4 450 � BY BY - _ DEPUTY �b DEPUTY BY BY ® DEPUTY DEPUTY