HomeMy Public PortalAbout9063 ACASO DR_Sewer_6/28/1956 6 d E•663 12.54 APPLICATION�..FOR PERMIT
DIVISION OF BUILDING AND SAFETY S EVIL E R-S EWAG E DISPOSAL
Deportment of County Engineer [� j�
County of LOB Angeles BUILDING
� �, // ICA CU ��
WM.J. FOX, COUNTY ENGINEER ADDRE
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY 7''���LE �•T�
FOR APPLICANT TO FILL IN NEAREST
CROSS Si.LEGL
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DE CRIPTION LOT NO. 7 ��� OWNER G (moi' J� lT'/✓ �v f 'p
BLOCK TRACT MAIL {� ��/
9
/j, b / ADDRESS C /"�
SIZE OF LOT. � /'.I , NOW ONBLOTSY c_
CITY r TEL. N0.
USE BUILDINGS �U� ' /�" L �I Cy
�,,/ ,J ` Al // ,/ DISTRICT N0. GROUP MAP
CONTRACTOR
A 6f/�ri/U 6`� 6 /q 0 cA � I � I BK PG
ADDRESS � - � `� ' CONNECTION DATA
J3 S /� r5,A# A-"r/4
CITY ! Iii C TEL. NO. 47--/,79 7 -/
E 7 1 STATION � � DEPTH 4 >
REGISTRATION N0. //6 `( *� 9COLINTY / A / I ANHO REFERENCE LOWER'
TYPE NECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE li/ CURB .moi M.L.70 P.L. � rt
'd HOUSE SEWER CONNECTING TO
PUBLIC SEWER a $ 3.50 J V
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR - CO. IMP. NO. 3 -7 -1
JOB. NO.
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING /��
SEWER OR DISPOSAL SYSTEM 1.00 - TRUNK PERMIT NO. ROAD PERMIT NO 6-(61 9W
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
_
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE 44 REIMBURSEMENT FEE
HAVE IDATETHE �y /e
TRACTORTTO CONNE TO THE ABOVEWDESCR BEDH EXISTINGA hDWELL IN APPROVALS Dpi I INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS +- DAY OF r CL33=�_ 19 � NEW HOUSE SEWER
CONNECT ADDITIONAL .
OWNER OR BUILDING OR WORK
OWNERS AGENT
T
SEPTIC TANK, SEEP, PIT(S)
ADDRESS f1� AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL ElAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM /
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ,7
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER /
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, i
BACKFILLSTANKS❑ t ^f<��1"Qi�3✓` SEEP.PIT(S)
[3❑ CESSPOOLS S -
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
BY l',l%+ sY 5 5 JJN
DEPUTY DEPUTY
BY BY
�® DEPUTY
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