HomeMy Public PortalAbout9042 ACASO DR_Sewer_7/31/1953_13581S DEI�AZtsmIENT q�F COUNTY ENGINEER
SEWER—SEWAGE DISPOSAL
DIV146Nk.'OF BUILDING AND SAFETY F<r PERMIT APPLICATION
COUNTY OF LOS ANGELES
-"' WILLIAM J. FOX, COUNTY EN13INEER ADDRES3
FOR APPLICAWT FILL IN "'may LOCALITY C 1
BUILDING NEAREST -^
ADDRESS CROSS ST. 7 Z , �Q c E ,
e
-LOCALITY DISTRICT NO. yySERIAL NO,, PERMIT NO.
NEAREST <= S
CROSS ST.
rim Y Ready for Inspection DATE ISSUED
OWNERru
MAIL V ADDRESS C OBIC
ZO E PANCY I MAP G
��� �, .� PG
CITY. TEL.NO. ;If
CONTRACTOR CO.IMP.NO.
ADDRESS
JOB NO.
CITY ^ TEL.NO. 7 L° TRUNK PER STATf NO.
13 �- yY `7' E)COUNTY
REGISTRATION N0. ROAD PERMIT NO.
LEGAL r� STATE ENCROACHMENT
DESCRIPTION ,y� LOT NO. �""e PERMIT NO. --
BLOC LYSI TRACT J,CC e P;/S /G l (� INDUSTRIAL
WASTE APPROVAL - -
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNE TIAN CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE '
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE .. BY
HOUSE SEWER CONNECTING TO I ^"
PRIVATE DISPOSAL.SYSTEM 1.00
' CONNECT ADDITIONAL BLDG.OR yXC TION RECORDED
WORK TO HOUSE SEWER 1.00 1 _
ALTER OR REPAIR EXISTING NO DATE 18Y
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 2.00 -
CESSPOOL—DRYWELL STATION DEPTH --
_SPECIAL CONDITIONS ONLY 2.00 _ '"'•.MANHOLE REFEP,ENCE.�P
'`UPPER " LOWER
TYPE OF CONNECTION----'- ,,,LENGTH FROM
Y. CURB.,----P.L. M!L.TOP.L.
OWNERS PERMIT $ 1 00 -
AUTHORIZATION I TOTAL FEE 1 7c>r, �
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE D RIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..... .........DAY OF--- _-- ............._......Iq_)]> NEW HOUSE SEWER
OWNER
- OR CONNECT ADDITIONAL
OWNERS AGENT.--A 4BUILDING OR WORK -7
------- ^`
EPTIC TANK,SEEP.PIT(S)
ADDRESS---��_ +-------------------�as-----------. ......... AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL(] DRYWELL I]
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 HER
CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS'ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I A THE LEGAL OWN-
ER OF THE ABOVERIBED RESI I L PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)� CESSPOOLS
IOF PERMT _ . -
70A042D
663 1/53