HomeMy Public PortalAbout9068 ACASO DR_Sewer_4/1/1953_5856 S DEPARTDIENT OF COUNTY ENGINEER I SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES ��
' WILLIAM J. FOXY COUNTY ENGINEER BUILDING / O
ADDRESS 7 C7/r (r'�.�•�.�'�,.'�.L /,t(,�+
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FOR LOCALITY _
APPLICANT TO FILL IN _
e
BUILDING NEAREST
NEAREST
ADDRESS LLJJ CROSS ST
LOCALITY ��� � '�L �r--G' `DISTRICT NO /SERIAL NO f�PERMIT NO c
NEAREST �` �� 5 A "p 3 •Fa 51 �y L J
CROSS ST .�.!
IVr,,,LC/J-ED BY Ready for Inspection DATE SSU
ED
OWNER
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MAIL ¢ ��� �+E USE ZONE OCCU ANCY MAP''
ADDRESS /J
BK PG
CITY r"/J4---TEL NO
CONTRACTOR, *0_7— 0 Oe-f • CO.IMP NO /
ADDRESS A;: /`D 0 l L-L JOB NO - M
CITY ' TEL NO TRUNK PERMIT NO' [...--.-
L STATE
REGISTRATION NOqq/G ROAD PERMIT NOW 2` 7
LEGADESCRIPTION, LOT NOW & jn()G7 =-k/ j5-7,.tf STATE ENCROACHMENT
PERMIT NO
BLOCK4 �OtTRACT A:'/ fi.S, I.I I J ( INDUSTRIAL
T
4 • t WASTE APPROVAL
NO 8F SLOGS
-�-
SIZE OFULOT �NO�rW ON LOT •� CHARGES
OF
BUE DINGS e///L/
CONNECTION CHARGE FEE\
NO DESCRIPTION OF WORk FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLICSEWER 0 $ 350 - RECEIPT NO DATE1`_ IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 I
CONNECT ADDITIONAL BLO6 OREXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER 8R REPAIR EXISTING /NO ( DATE BY
SEWER OR DISPOSAL SYSTEM 100 /
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION " ► v 5 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 / / MANHOLE REFERENCES 1
.UBRER �/ LOWER
` TYPE OF-dOhNECTION LENGTH FROM
OWNERS PERMIT $ I 00 P._
---- CURB - L.- ML TO P L I iD
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT
THEA DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO E P LIC SEWE 1
SIGNED THIS Y ___ __. NEW HOUSE SEWER ��1/�(
OWNER OR CONNECT ADDITIONAL v
OWNERS AGE _ _ BUILDING OR WORK .� C
SEPTIC TANK,SEEP PIT(S)
ADDRESS _ _ - - AND/OR DRAINFIELD V
I HEREBi ACKNOWLEDGE THAT I HIV EAD THIS APPLI- CESSPOOL❑ DRYWELL e IFLr
CATION AND STATE THAT THE ABOVE IS ORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSa ALTER REPAIR,SEWER OR J
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY C Y THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
r /
AND/OR LIC ED S REQUIRED BY LOS ANGELES COUNTY �G f
AND STAT F CA FORNIA OR THAT I A THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF TH AGOV DESC D RESIDEMAL PROPERTY , BACKFILL SEPTIC TANKS -
SIGNATURE SEEP PIT(S) CESSPOOLS
OF PERMIT
i
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