HomeMy Public PortalAbout5419 BALDWIN AVE_Sewer__ (2) DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAV
DIVISION OF BUILDING AND SAFETY - PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER BUILDING p
` ADDRESS l7df(J
FOR APPLI A T TO_FILL IN LOCALITY � X� � _
ADDRESS BUILDING J Ct/` NEAREST
CROSS ST L�1
LOCALITY ~ DISTRICT NO�y /SERRIAL NO PERMIT NO
NEAREST ^cam/ A / 0 ��S
CROSS ST y D Ready for Inspection DATE ISSUE
OWNER -r-
r z —53
MAIL US ONE f OCCUPANCY MAP
_ADDRESS�rq I BK PG
CITY TEL NO - Dcs
CONTRACTOR c CO IMP NO ! —.
ADDRESS /'1 JOB NO
CITY TEL NO �� L TRUNK PERMIT NO
TE
TA
REGISTRATI N NO COUNTY ROAD PERMIT NO 9(?L
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT&I`wM (lam- z INDUSTRIAL
0OFr WASTE APPROVAL
SIZE OF LOTko x;_��-�MOW ON LOTS L CHARGES
USE OF
BUILDINGS CONNEC CHARGE FEE
NO DESCRIPTION OF W130K VtEL REIMBURSEMENT
HOUSE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 350 RECEIPT NO DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR RPA-IR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 I I DATE 1(�
DISCONNECT AND ABANDON SEWER i \`
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA 1
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATION -3, DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 `S M NUHOLE PPER EFERENC
TYPE OF CONNECTION LENG ROM
OWNERS PERMIT $ I 1 00 CURB _P�1� ML o P L
AUTHORIZATION TOTAL FEE I S 0
HAVE ED
CONTRACTOIR TO CONNECT THATE TE ABOVE D SCRIBEDED WITH THE I EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF _ _ 19 _ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AG _ /L � BUILDING OR WORK
J ,-. � �,,,,_ SEPTIC TANK SEEP PIT(S)
ADDRESS
klfa'L' AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL❑ DRYWELL E]
CAT
IONAND 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
AD STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN Q ( '
,ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS�
T ❑ 1 s /L1;{i [j "7� f
SIGNATURE SEEP PIT(S) CESSPOOLS
OF PERMITTEE
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76A642D 603 1/53