HomeMy Public PortalAbout4846 AGNES AVE_Plumbing_12/15/1953_19514S DEPARTBlENT OF COUNTY ENGINEER SEXIER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN 1 LOCALITY
BUILDING YgyG fjJ ` // i,,,�', CNEARESTROSS ST �®&0009! !
ADDRESS / y 44 11 /.C�'l'Y(
LOCALITY _ 1 0 r A DISTRICT NO SERIAL NO PERMIT NO
A Sl�/ S
NEAREST
CROSS ST A
_,\, �}+ RECEIVED BY Ready for Inspection DAT ISSrUEr,�
OWNEOO,e �AM Ir{�(f�r1N� n 'I lA�� 4WWIi7 5—
MAILADDRESS kJ i6'40 3 I 1 �+r 18�bG{ USE ZC�� OCCUPANCY BK MAP PG
CITY TEL � �� � ��/ ��� � 7s
CONTRACTORrd =1�6 1
CO IMP NO V
ADDRESS �! /;-. JOB NO
CITY / ��w TEL NO -,,e
"i TRUNK PERMIT NO
STATE
REGISTRATION NO B COUNTYI ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO SOW _ 1 STATE ENCROACHMENT •
PERMIT NO
BLOCK TRACTlZfflqjQ U INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO OF BLOGS
USE ® �0 NOW ON LOT }���� %It
CHARG
BUILDINGS -_R I S I DL- hC-F CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Qr2 $ 350 Q} RECEIPT NO DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
e
CONNECT ADDITIONAL BLDQ OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 j
ALTER OR REPAIR EXISTING ` NO I DATE I BY
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 • DEPTHCESSPOOL-O �O�
YWELL
SPECIAL CONDITIONS ONLY 200 /� f I A FERENCE rr/��
(o /• \ PP /� !/•E 'iER
TYPE OF CONN CTION LENGTH FROM
_OWNERS` PERMIT ; I pp ' Y t9--Br .P_m M L TO PL .G
AUTHORIZATION- TOTAL FEE S
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOR SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS I Z DAY CIF �G Iqb?� NEW NOOSE SEWER
OWNER OR4 9 _ S ' CONN
0191 k MOIY•AlECT ADDITIONAL
OWNERS AGENT _ _ BUILDING OR WORK
.I'D SEPTIC TANK SEEP PIT(S)
3
ADDRESS 6 �� elJ" _ _ AND/OR DRAINFIELD
1 HEREBY ACKNOi DV /r HAY-'I rlfAV READ THIS APPLI CESSPOOL[] [3DRYWELL
CATL'E
ION AND STATE THAT THE ABOVE IS RRECT 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 REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I A E LEGAL OWN
ER OF THE ABOVE DE CRIB�ED RESIDAF17AL
,PRO'PE�RTI�Y J BACKFILL SEPTIC TANKS
81GNATURE �� SEEP PIT(S)��CESSPOOLS
OF PERMITTEE tL •_
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