HomeMy Public PortalAbout5709ALESSANDRO AVE_Sewer DFPARTIbIENT OF COUNTY ENGIIVEER }
SEWER-SEWAGE DISPOSAL
DIISION OF BUILDING AND SAFETY f
l COUNTY OF LOS ANGELES PERMIT APPLICATION
WILLIAM J FOX, COUNTY ENGINEER BUILDING
ADDRESS g-7
�f �+—
FOR APPLICANT TO FILL IN { LOCALITY Qp
BUILDING n `� �j/,ry 0� �, 1 NEAREST C_
ADORE SS �N �iZ4.G4, jy!�6/� x CROSS ST ��k�
LOCALITY i DISTRICT NO SERIAL NO PERMIT NO
NEAREST
CROSS ST
R EI ED BY Ready for Inaoeotion DATE ISSUED
OWNER _ elk /iz
MAIL k'
ADDRESS USE ZONE OCCUPANCY BK*'&—
PQ
CITY ( �J TEL NO / `
CONTRACTOR CO IMP NO
ADDRESS JOB NO
CITY TEL NOLl 4 414-: TRUNK PERMIT NO
REGISTRATION NO Y-7 �' COUNTE TYI /�
ROAD PERMIT NO
LEGAL �/ STATE ENCROACHMENT 1—r
DESCRIPTION LOT NO (O �1 �7(O PERMIT NO t
BLOCK TRACT (� v-�QC� INDUSTRIAL
--T WASTE APPROVAL
SIZE OF LOT 6 Q NO OF BLDGS CHARGES
NOW ON LOT y
USE OF
BUILDINGS � CONNECTION CHARGE FEE x
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ j 350 SV RECEIPT NO 'I/ DATE \ IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR �� EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO
ALTER OR REPAIR EXISTING DATE I OY
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/OR DRAINFIELD 200 STATION —3 . DEPTH
14
CESSPOOL—DRYWELL
SPECIALCONDITIONS ONLY 200 f � MANHOLE-REFERENCE ZrA LOWER
TYPE OF CONNECTION LENGTH FROM
CURB ��s ML TOP L
1 00
OWNERS PERMIT $
AUTHORIZATION TOTAL FEE �'
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS , _ DAY OF _ _ Iq ; NEW HOUSE SEWER
OWNER OR I CONNECT ADDITIONAL
OWNERS AGENT _ _ —Z-.< _ _ BUILDING OR WORK
% _ SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY AC CNO DGE THAT I HI E READ THIS APPLI ' CESSPOOL[—] DRYWELL
CATION AND ST HAT 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 IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AHD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY 1 ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN
ER OF THE ABOVE DESCRI RESIDENTIAL PROPE Y I BACKFILL SEPTIC TANKS T
SIGNATURE SEEPPIT(S)[3 CESSPOOLS
OF PERMITTEE
76A642A 663 7/53