HomeMy Public PortalAbout5019 DALEVIEW AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES Bu1tDIN
WILLIAM J. FOX, COUNTY EENOINEER I AGGRESSa
FOR APPLI T T FILL IN , LOCALITY
BUI LD NO /� / �j NEAREST 1C/ V Q w
AOD RESS (/[ / CROSSST.
LOCALITYDISTRICT NO. I Ready for Inspection `7PERMIT NO.
NEAREST A ,Y1 ' 7 5J /p J� S
CROSS ST. 4NID
/RE�CE/VE�D By DATE ISSU E�B�'Y/ a DATE
OWNER j"'/f `I'L'3'�9' �OJ✓GA[!/su ��i'.3 J
MAIL
ADDRESS �USEi ONE OCCUPANCY OI MAP
`� �l/I/Lp .
BK PG
CITY TEL.NO.
i
CONTRACTORC$llf Ornia Sewer COnSt r CO. CO.IMP.NO. /� V
ADDRESS 1317 Colegrove Ave.
JOB mg.
CITY Montebello TEL.ND.� TRUNK PE N0.
REGISTRATION H0. '04445 SWi$7 UNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. S 7s s �IT STATE ENCROACHMENT \ /
PERMIT NO.
BLOCK TRACT 0 INDUSTRIAL /
WASTE APPROVAL J
SIZE OF LOT NO.OF BL
_ NOW ON LOTOT
/CHARGES
BUILDINGS - CONNECTION CHAR E FEE ( \
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO q REIMBUF15EMENT FEE
1PUBLICSEWER 06 3.50 cll gECEIPTNO. DATE IBY
HOUSE SEWER CONNECTING;
L/
_ 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 '
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION L-;I' 30 DEPTH (o
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /a�/ MANHOCE'REFERENCE
.C` UPPER- L71W
TYPE Or CONNECTIO LENGTH FROM
OWNERS PERMIT $ 1 00 i
Y. Guwe• P.L: - //M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREI NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH PUBLIC SEWER p� /y
SIGNED THIS�___..DAY/�'jp �C1.�:C�.--19. 7 NEW HOUSESEWER �iNC/ 2O''T
�/•�/ /L � 6/ CONNECT ADDITIONAL
OWNERS AGENT_ r1G.^r_/V�__ BUILDING OR WORK
�y�/- .ti____._.__
ADDRESS....... _. ._ v 't'�''�lP)-P SEPTIC TANK,BEEP.PIT(S)
....._ ....-.___.-_._._.._.._.._.._.._.._._._.... AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL Q DRYWELL El
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATINGPLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIAOR TH T I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DE OR ED R 1 ENTIAL PROPERT BACKFILL SEPTIC TANKS E] n/
SEEP.PIT(S)Q CESSPOOLS /lYr
SIGNATURE
OF PERMITTEE. .. ._._.._.--- .. - . .._-........._ Odor
76AG42D S&E 663 4/54 i5�