HomeMy Public PortalAbout9064 ACASO DR_Sewer_5/11/1956 D
S&E-668 3.55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL �■81
Department of County Engineer
County of Los Angeles BUILDING
DRESS
WM.J. FOX, COUNTY ENGINEER
® CASSATT D. GRIFFIN,SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL �j
DESCRIPTION LOT NO. C �/// D ®o OWNER
BLOCK TRACT MAIL
ADDRESS
�j
� ^
SIZE OF LOT'50 a o NOWOONBLOTS - 7 3
CITY TEL. NO. 7-121
USE OF
BUILDINGS DISTRICT N0. I ( MAP�
CONTRACTOR BK G
ADDRESS CONNECTION DATA
CITY TEL. NO. �D STATION 3 ' j DEPTH
STATE MANHOLE REFERENCE O '
REGISTRATION N0. ,] VV ❑ COUNTY s � LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO _ TYPE ECTION LENGTH FROM 0
PUBLIC SEWER „s
Y. CURB P.L. M L. TO P.L. 70
HOUSE
@ $ 3.50 _ ---!
HOUSE SEINER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _ -
CO RK TO ADDITIONAL BLDG. OR /� `)� P.B O.
WORK TO HOUSE SEWER 1.00 CO. IMP. N0. / JOB N0.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. ROAD PERMIT N0. Q®
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00 INDUSTRIAL
APPROVAt
CESSPOOL- DRYWELL WASTE
SPECIAL CONDITIONS ONLY 2.00 CHARGES
S t o0
OWNER'S
PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE V REIMBURSEMENT FEE
I .HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPEC OR'SSIGNATURE
TO THE PUBLIC SEW_ER
7�
SIGNED THIS _DAY OF 19NEW HOUSE SEWER
_S? \� ��. _ •,Y,�_. M„�,�.
OWNER OR CONNECT ADDITIONAL
OWNERS AGE'. BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS . AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL El DRYWELL C1AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. PETER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEP.EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS.❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS l(p :�4 _ 0
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FLBG. INSPECTOR
5 9 1 c- tAY11 4 4.5 0