HomeMy Public PortalAbout5941 ALESSANDRO AVE_Sewer__ IDEPAltrMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX COUNTY ENGINEER BUILDING
ADDRESS jT L
lF_OR APPLICANTTO
_FILL IN LOCALITY
BUILDING
ADDRESSNEAREST
CROSS ST ✓✓ / �Ov
LOCALITY DISTRICT NO SERIAL NO PERMIT NO c
CNEAREST
ROSS ST ✓1 �+' A
IRECEIVED Ready for Inspection DATE ISSUJED
OWNERMAIL •l��s � �/Lr..-
ADDRESS /7 J USE ZONE OCCUPANCY MAPPG
CITY (, TEL NO q, � I �� �K /P /
CONTRACTOR O A? �r
CO IMP NO �"
ADDRESS
I JOB NO
33a
CITY TE/L�N TRUNK PERMIT NO 9 B
STATE ENCROACHMENT
REGISTRATION �y�NO 9 v _� COUNTY'
LEGAL ROAD PERMIT NO [� J57,$——7 Vj
DESCRIPTION LOT NO e I PERMIT NO
I
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
NO OF
SIZE OF LOT �,� J( 1 NOW ON LOTS CHAR ES
USE OF n
BUILDINGS iClCONNECTION CHARG FEE
NO DESCRIPTION O WOR F
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC_SEWER 0 $ 350 RECEIPT NO DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTIO RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING V.01 NO I D TE 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 ST DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 MAM�EFERENCEff
PP'E�) %%• i YOWFR
TYPE OF CON ECTION LENGTH FROM
OWNERS PERMIT $ 1 00 CUW CP-L- ML TOP L Z�S
AUTHORIZATION TOTAL FEE 25 /"ffv '°a .0 / lel 4A,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR S SIGNATURE DATE
SIGNED THIS Y OF t 19 _ NEW HOUSE SEWER
DOWNER OR --� CONNECT ADDITIONAL
OWNERS AGENT _ _ BUILDING OR WORK
ADDRESS�� _ _ EPTIC TANK SEEP PIT(S)
ND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI ESSPOOL 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 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 ��I� .�'♦ �° SEEP PIT($)[] CESSPOOLS
OF PERMITTEE ✓ �tg �F� t �� F _
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