HomeMy Public PortalAbout4945 BALDWIN AVE_Sewer__ y DFPARTWNT OF COUNTY ENGINEER SEINER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
s COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER ADDOTT
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FOR APPLICANT T ILL IN LOCALITY
NEAREST
ADDREUILDSS y���/jy t �jfjr//YI�I ��! CROSS ST h
oI
LOCALITY fI DISTRICT NO SERIAL NO PERMIT NO
CROSS ST a- A 1934-4-1
ECEIVED BY Ready for Inspection DATE ISSUED
OWNER,('-,,MAILG '/�1 /��j
ADDRESS�/ �70��/�� ��/�/j� �j / G USE ZON OCCUPANCY BK MAP PO
CITY)Y: // / fi'� T O xD -9-C "?( r'
CONTRACTOR
CO IMP NO C) —
ADDRESS � � JOB NO
I® I
CITY
'/TEL N� TRUNK PERMIT NO
STATE
REGISTRATION NO r--*' ,,S B COUNTY
ROAD PERMIT NO 2 � S •�'4 I �
LEGAL v I STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT INDUSTRIAL
��,,//��
WASTE APPROVAL
NO OF BLDG
SIZE OF LOTL�61� J 70 NOW ON LOTSS4010 CHARGES
USE OF
BUILDINGS�/f� f�I��Lt /�1 CONNECTION GE FEE
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ ; 350 Ls RECEIPT NO DAT BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING I DATE I BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONAND/OR ABANDON
N ORD DISPOSAL SYSTEM
SEWER too- CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATION I Q DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2004_,4",7 MANHOLE REFERENCE
CLOCrTW
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I I 00 fM M L TO P L
AUTHORIZATION TOTAL FEE r I bC�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER / �
SIGNED THIS � _DAY OF per- W-A _I�� NEW HOUSE SEWER,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT���'V ! __ _ BUILDING OR WORK
� a�fL SEPTIC TANK SEEP PIT(S)
ADDRESS J CE AND/OR DRAINFIELD
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL[j 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
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I 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 AM THE_LEGAL OWN
ER OF THE ABOVE DESCRIBED RESIDENT OPERTY BACKFILL SEPTIC TANKS
SIGNATURE r SEEP PIT(S)[:] CESSPOOLS
OF PERMITTEE
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