HomeMy Public PortalAbout9058 ACASO DR_Sewer_10/13/1954_35605S DEPARTMY:NT OF COUNTY ENG1NEER SEVER-SEWAGE DISPOSAL. 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I NG
ADDRESS
ADDRESS
R APPLICA T TO FILL IN LOCALITY
BUILDING �y ca NEAREST
n
ADDRESS (/ C 0 �A CROSS ST.
LOCALITYDISTRRICT NO. SERIAL NO. PERMIT NO.--
NEAREST S A ��i�L7
CROSS ST.
�:� REgEIVEDBY Ready for inspection DATEU�E
OWNER
MAIL USE ZONE OCCUPANCY
ADDRESS
BK PG
CITY TEL.NO. �.-/
Z>
3A . "� -A mss" CO.IMP.NO. � 27 - ��
CONTRACTOR �(
ADDRESS
' A , JOB.NO.
CITY //�® 1-7
TEL.N0. �
TRUNK PERMIT N0.
�7J— -3 [ISTATE
REGISTRATION NO. ® meq' ROAD PERMIT NO.
LEGAL s STATE ENCROACHMENT
DESCRIPTION LOT NO. ,r a" ; . PERMIT NO.
BLOCK TRACT �� f Y �r �, F¢ INDUSTRIAL
-,k 1 ref t WASTE APPROVAL
SIZE OF LOT K ' NO OV BL
.-
1
NOW ON LOT CHARGES
USE OF
BUILDINGS ,6 \ S CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE- HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
71- HOUSE SEWER CONNECTING TO $ 3.50 RECEIPT NO. I d`pATE I BY
PRIVATE DISPOSAL SYSTEM 1.00 f If `�
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' I DATE �� I 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/ORDRAINFIELD 2.00 STATION �'(p DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 gL�� ) n MANHOLE REFERENCE
{ vV �.- LOWER
TYPE.OF CONNECTION LENGTH FROM l� g
OWNERS PERMIT $ I 00 `" CURB P.L.M.L.TO
AUTHORIZATION .I TOTAL FEP� .� ,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEC OR'SSIGNATURE DATE
DWELLING TO THE�BLIC SEWER � �
SIGNED THIS--___,,,�_--_-__ D Y OF___ _____________._._.._.______...I NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT. r '�r BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..... - - ....... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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
1 HEREBY 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 A THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED REST >:�N A^PROPERTY. BACKFILL SEPTIC TANKS r
SIGNATURE SEEP.PIT(S)E] CESSPOOLSlrarvAr
OF PERhitTTEE-_.. 7 r Pr
76A642D 663 1/53