HomeMy Public PortalAbout6042 PRIMROSE AVE_Sewer_4/13/1953_NEW HOUSE SEWER DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICA T Ft:L L IN LOCALITY e�
BUILDING � NEAREST
ADDRESS w !� CROSS S.
LOCALITY DISTRICT NO. SERIAL NO.
PERMIT NO. c
NEAREST As rp; J
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADDRESS +�--tl��is�a�y BK PG
CITYTE N0.
CONTRACTOR? yysss 96�a CO.IMP.NO.
ADDRESS � 1 ,f + ✓ - JOB.NO.
CITY TELAO.
TRUNK PERMIT N0. - - --
REGISTRATION NO. fz�3
+ -t-COU-
OfiUNTY ROAD PERMIT NO.
LEGAL DESCRIPTION LOT NO. J � STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT f INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT " N0,OF BLDGS.
��// NOW ON LOT I& CHARGES
USE OF
BUILDINGS �� CONNECTION CHARGE FEE
NO. DESCRIPTI N OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. DATE I BY
^-HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00_
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER L00 ,'
ALTER OR REPAIR EXISTING kQ i DATE I BY
SEWER OR DISPOSAL SYSTEM l.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I ( CONNECTION DATA
lSEPTIC TAkK,SEEPAGE PIT OR ff
�f-PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE
OER EFERENCE
TYPE OF CON!!!ECTION LENGTH FROM
CURB,% M.L.TO P.L.
OWNERS PERMIT $ ! 1 00 "
AUTHORIZATION I TOTAL FEE C
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P BLOC SEWER
SIGNED THIS--- ___DAY OF.:_ ._AAJO" e 19 NEW HOUSE SEWER
OWNER OR ^ CONNECT ADDITIONAL
OWNERS AUNT..... ..�.
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS _ AND/OR DRAINFIELD
I HEREBY ACK OWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] 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
;'EGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
s 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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS �—
s SEEP.PIT(S)[] CESSPOOLS[�.
d
OF PERMITTEE
OTTEE
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