HomeMy Public PortalAbout5606ALESSANDRO AVE_Sewer DEPAItr11iENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
AIVISION OF BUILDING AND SAFETY '
5 PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER I BUILDING SGo`�-o6 ,.S,.4�c/Q.e
ADDRESS
D
FOR LOCALITY TO FILL LOCALITY
BUILDING
ADDRESS �CS Dl�G NEAREST
ST
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
J
NO c
NEAREST 6- A ~�_ / 6(/ 7
CROSS ST a.
RECEIVED BY Ready for Inspection DA E ISSyED
OWNERMAIL /��i!�
ADDRESS � �� �,� USE ZONE OCCUPANCY BK AP PG
CITY TEL NO
CONTRACTOR CO IMP NO s 69—'047)
ADDRESS JOB NO
CITY TEL NO � � TRUNK PERMIT NO—
REGISTRATION REGISTRATION NO (�3 C' ��� GOALitlidN ROAD PERMIT NO zs,J''7,�
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
��/—O'Q �,. ,.� PERMIT NO
BLOCK TRACT ��� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT7.6l /d:VNOW ON LOTej0Nl OF S CHAR S
USE OF
BUILDINGS CONNECTION CHARGEXEE
r NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO n
PUBLICSEWER @ $ 380 S RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR / �d EXCEPTION R ORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING HOI DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER ONNECTION DATA
AND/OR DISPOSAL SYSTEM 1 00
SEPTIC TANK SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 200 STATIO DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 /f MANN REFERENCE
a i� LOWER
Y TYPE OF CONNECTIO � _VLN_TO P LOM
OWNERS PERMIT ; =310 -7.2 S� -
AUTHORIZATION TOTAL FEE 1� �l7 '
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED " 2
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS /1 D Y OF _ ly__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENt '/c ���� _ _ BUILDING OR WORK
ADDRESS /^Af!�V ��_f-P-,"4SEPTIC TANK SEEP
AND/OR DRAINF ELD PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL Ej DRYWELL E]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 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE l�C/D� �� a SEEP PIT(S)� CESSPOOLS
OF PERMITTEE _ _ _ _ I
76A642A 663 7/53 /j