HomeMy Public PortalAbout6039 ALESSANDRO AVE_Sewer__ i -- -- -
DFPARTMEN'T OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES G ,
WILLIAM J FOX, COUBUILDIN
COUNTY ENGINEER I ADDRESS,Q3 .�S�ol/�e�®
FOR APPLICANT TO Fl L I LOCALITYNG
T C,
ADDRESS v CROSS ST
LOCALITYDISTRICT NO SERIAL NO PERMIT NO
NEAREST �&' A
CROSS ST
RECEIVED Y Ready for Inspection DAT ISSUE
OWNERMAIL
ADORES �}' l US ZONE' OCCUPANCY BK M P PO
CITY TELNOff 17 Z
, (% 7,71
CONTRACTOR �.i4 x.C�r(N r� �I CO IMP NO /3 (f
ADDRESS J JOB NO
CITY �J TEL NO Q G��
❑ ( TRUNK PERMIT NO
REGISTRATION NO _7 v C— ICY ROAD PERMIT NO
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If
D CRIA
SPTION LOT NO 41,640, �� �G7 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT I INDUSTRIAL
EWASTE APPROVAL
SIZE OF LOT NO W
X (/� NOW ON LOTS CHARGEUSE OFS
BUILDINGS /� !J✓L CONNECTION CHARG FEE
NO DESCRIPTION OF WORK FEE Ar
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER EES $ 350 �Gt 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 NO D T� 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/d-7ii'- y,O DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 7 ANHOLE REFERENCE LOWER
TYPE OF CONN CTION LENGTH FROM
OWNERS PERMIT $ I 00 CURB fP 0 ML TO P L /
AUTHORIZATION I TOTAL FEE 1 :50% ,
I
HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED'
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER r
SIGNED THIS -L)j DAY OF _ _ 19 NEW HOUSE SEWER ✓U 7`
OWNER OR4 _,n CONNECT ADDITIONAL
OWNERS AGENT)-WL-41�1 �T i n C�` _ I_ BUILDING OR WORK ^
SEPTICTANK SEEP
ADDRESS I L_I �G 1 � 'GLA AAe E � _ 1 AND/OR DRAINFIELD PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 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
I HEREBY 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 OWNj�n
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE _ // j' ' / SEEP PIT(S)Ej CESSPOOLS<g -
OF PERMITTEE {O- b _
76A642A 663 7/53 ,�b % G�� �✓�`