HomeMy Public PortalAbout5836ALESSANDRO AVE_Sewer DEPAIC17 ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX COUNTY ENGINEER (�ADDRESS ,_� r_
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS S3,342 CROSSST
LOCALITYT !� DISTRICT NO SERIAL NO PERMIT NONEAREST C
CROSS ST p1 `e{� SGV' e�f J
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER // �j
MAIL
ADDRESS ��� p J�,.� R USE ZONE _��C jP�Af�CY BK MAP PG
CITY TEL NO �oZ/; C
CONTRACTOR CO IMP NO e
ADDRESS
QQ JOB NO /
CITY TEL NO /p'� S TRUNK PERMIT NO
REGISTRATION NO 3 -`_.34 COUNTY ROAD PERMITLEGAL
DESCRIPTION LOT NO 74 SERMIT NENCROACHMENT
BLOCK TRACT S ` r , INDUSTRIAL
NO OFBLDGS WASTE APPROVAL
SIZE CF LOT d NOW ON LOT �-- \ CHARGES
USE OF
BUILDINGS Y'G f CONNECTION CHARGE FEE
NO DESCRIPTION OF W130K FEE \ r
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE /
PUBLIC SEWER @ $ 350 RECEIPT NOIA
J� DATE I BY
HOUSE SEWER CONNECTING TO / \
PPIVATE DISPOSAL SYSTEM 1 00 `
ICONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 / b8
ALTER OR REPAIR EXISTING NO, DATE IBY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND AND/OR DISPOSAL SY STEMN SEWER 1 00 /
CONNECTION\DATA
SEPTIC TANK SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 200 STATION / DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 / MANHOLE REFERENCE
UPPER \ LOWER
TYPE OF CONNECTION LENGTHNFROM
OWNERS PERMIT $ 1 00 Y / CURB Pt. M L TOCP L
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR S SIGNATURE DATE
SIGNED THIS DAY OF n , 19 V.5 NEW HOUSE SEWER / g
OWNER OR 4r _ BUIILDING ORNECT ` J i 7.2 3
SEPTIC TANK SEEP OWNERS AGENT 1111 S- �� �J" �GGer�t _
UAND/OR DRAINFIELD PIT(S)
ADDRESS _ _ _ _ _
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL E] DRYWELL
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
LSIGNOF PERMITTEE SEEP PIT(S)� CESSPOOLS[-]
ATURE
76A642D 663 1/53