HomeMy Public PortalAbout5209 BALDWIN AVE_Sewer__ (2) DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUPT of BUILDING ADDRESS
FOR APPLIC NT /�FILL IN LOCALITY
BUILDING `/'� '' NEAREST
5j+
ADDRESS d �/�i/� GROSS ST.
LOCALITY 'C DISTRICT NO. SERIAL'-N#-.' PERMIT NO. C
NEAREST °l �C �.i A ("� / ^'
CROSS ST. ' RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Per I'p, O
MAIL /►y _(f �/
ADDRESS �.7 USE ZONE OCCUPANCY MAP
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CITY 1 TEL.NO, asp �� Z,
CONTRA , fro CHARGES REIMBURSEMENT FEE
ADDRESS 3 l�`o D T ' REQUIRED
NOT REQUIRED
CITYTEL.NO. S P JOB.NO. CONNECTION CHARGE FEE
/ STATE
REGISTRATION NO. COUNTY CO.IMP. NO. �•_
LEGAL �j RECEIPT NO. DATE BY
DESCRIPTION LOT N0. 6e 7`14 ,(O -
BLOCK TRACT F x 2—G 1 WAIVER FOR RECORDING
N0.OF BL ` RECEIPT NO. DATE 13Y
/yT 1aJ NOW ON LOTT
SIZE OF LOT
USE OF �,���/, �
BUILDINGS f 4,1
NO. DESCRIPTfDN OF ORK FEE TRUNK PERMIT NO.
HOUSE SEWER CONNECTING TO ROAD PERMIT NO. /
PUBLICSEWER @ $ 3.50
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER +
AND/OR DISPOSAL SYSTEM 1.00 STATION - DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00MANHOLE REFERENCE r
CESSPOOL—DRYWELL I� UPPER ''v . . L-OWER
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM
Y. CURB-. P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 00 —
AUTHORIZATION I TOTAL FEE
1 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._31 .._.D Y OF-_.....(,/Ll-+ ---------- 19__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.- -............._._----•.---.--_----- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED EQU'IRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CA FO NIA CR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DECRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE
OF PERMITTEE____ __________ t
f 6A6421) 663 12/52
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