HomeMy Public PortalAbout5109 DALEVIEW AVE_Sewer_12/2/1954_38521S CONNECT HJOUSE SEWER TO PUBLIC SEWER DEPARTMENT OF COUNTY ENCONEEB SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
- COUNTY OF LOS ANGELES
WILLIAM J. FCX, COUNTY ENGINEER I BUILDINGADDRESS
BUILDING C/O p •i/ n
FOR APPLICjkNT TO FILL IN LOCALITYNEAREST
ADDRESS I0 C CROSS ST.
q �Fldcuicu) — _
LOCALITY C- , DISTRICT NO. Ready for Inspection PERMIT70.
NEAREST _ ` 5� C/ 7(
CROSS ST.LL--, QQ`O W0 a /o YEDBr DATE` pD/ISSUED
�BBY�J DATE
OWNER l'.1�- I L`M L ifI s')MAIL
ADDRESS. 11102 USE ZONE �0�CU PANCY (� BK MAP PB
CITY 1 e TEL.NO. - --'I -
a*
CONTRACTOR7;tz�vi.) (4 zcS)LO(/ Ic.„ N0:
/ CO.IMP.
ADDRESS !'S'� �.� L� �� _ y
.LB No.
CITY (�/ �Q� TEL.Ns. o
`-� ❑ BB TRUNK.PERMIT NO.
REGISTRATION NO. / �� / 7 f}Cp1UlSY
ROAD PERMIT 0.,� /
LEGAL `C STATE ENCROACHMENT
DESCRIPTION LOT N0. J PERMIT N0.
BLOCK TRACT I CUa O INDUSTRIAL X
WASTE APPROVAL / \
SIZE OF LOT 7(�yC 1 N0.OF BLOTS.
NOW ON LOT � CHARGES
USE GF
/ \
BUILD,NGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE / \
H OUSES EWER CONNECTING TO
REIMBURSEMENT FEE
PUBLICSEWER ® S 3.50 �D /RECEIPT NO. I DATE IBy
OUSE SEWER CONNECTING TO
-PRIVATE
_ .DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
' WORK TO HOUSE SEWER 1.00 _
— ALTER OR REPAIR EXISTING - NO. I DATE IBY
SEWER OR DISPOSAL SYSTEM 1.00
GISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION. �'F ,�JJ - DEPTH / 0
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
IOb
+1� --9UP_P-ER. LOWER
TYPE OF CONN JLENGTH FROM
OWNERS PERMIT { I W Y. cure P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE 4 To
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEW - APPROVALS INSPECTOR'S SIGNATURE DATE
ER
SIGNED THIS AY OFA C' 19-6-1 NEW HOUSE SEWER
OWNER OR l� t Bf�l BUILDING
CONNECT ADDITIONAL
OWNERS AGENT. ---_-- - ..!/��8 BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(8)
ANTIC TANK,BEEP.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Q DRYWELL E3
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
1 HEREBY CERTIFY THAT I AM PROPERLY BEGIS.-- DISCONNECT PLUG AND
AND/OR LICENSED AS DESCRIBED
ff
COUNTY ABANDON NOOSE SEWER
AND STATE OF CALIFORNIA Ofl THCAL OWN-
ER OF THE ABOVE DESCflIeEO
RE
flTY. BACKFILL SEPTIC TANKS'� SEEP.PIT(8)Q CESSPOOLS
SIGNATURE
OF PERMITTE - - .,,G
76A6421) S&E 4/54