HomeMy Public PortalAbout5025 DALEVIEW AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER ;� • SEWER—SEWAGE DISPOSAL.3 3 8 51
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES ' .. . )
WILLIAM J. FOX, COUNTY ENGINEER ADD DING L �.
I'I ADDRESS /-
FCI APPLICANT TO FILL IN j LOCALITY- 'EL �t%f 0//7;0
ADDRESS 5A25Daleview I CROSSST.
G- /✓D ..9.i�F..
LOCALITY CC�i`1 (yn,�2�0ntenDISTRICT NO. - SERIAL NO. P,ERRMMITMO.,"
CROSSST. `. iV/)J�LtCJ� I �.. . .A. i�;70D 7 S
{ -RECEIVED BY Ready for Inspection- DATE.ISSUED
!/,/
OWNER RuSSell LanierMAIL
ADDRESS same -� USEZONEOCCUPANCY*.NSK' PG PG
(( h I.' /
CITY - TELO: - ', S/�1'✓/1/�F �
.J
CONTRACTQY_j'gp nTn lA ,Se47er Const.Co. COMP.NO.
ADDRESS 1T.;ii17 en1egrOVe Ave. . JOB NO.
CITY Mint PhPT 1 n TEL.Iffil On 1-5048. TRUNK PERMIT NO.
-STATE - - -
REGISTRATION N64445 Std®EFOUNTY1 ROAD PERMIT NO.
LEGAL �O/ n;-
y STATE ENCROACHMENT
DESCRIPTION LOT NO. /J/' 1 ) _ PERMIT N0.
BLOCK TRACT./r-�Dy�•-' D - . INDUSTRIAL
���yyyyyy ♦,, ! WASTE APPROVAL.
SIZE OF LOT D:Y..��""Q NOW ON LOTS �- CHARGES
USE OF
BUILDINGS Res CONNECTIORC EFEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
'3eCJ0 �
PUBLIC SEWER Q S 3.50 RECEIPT NO. ' DAT BY
HOUSE S T
EWER CONNECTING O
PRIVATE DISPOSAL SYSTEM IAO _
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER-" - 1:00 '
ALTER OR
REPAIR EXISTING NO. I DATE IBY -
_SEWERORDISPOSALSYSTEM E00
DISCONNECT.AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM. - Lou - "' CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD .2.00. STATION 3 %y 3 Q• DEPTH - 6 -
_ CESSPOOL—DRYWELL - - - -
SPECIALCONDITIONSONLY .2.00 / IAN. �! FERENCE �
:..) _ _
TYPE OF CONNECTION' ENGTH FROM
OWNERS PERMIT' $: 1 00 Y. CURB P.L: M.L.TO P:L. ]]
AUTHORIZATION I TOTAL FEE': 4.50-
`JHAVE THIS DATE CONTRACTED WITH THE HEREIN.NAMED
'CONTRACTOR TO CONNECT THE ABOVE DESCRIBED'EXISTING_ APPROVALS INSPECTWSSk fi ATURE DATE
,'DWELLING TO THE PUBLIC SEWER
SIGNED-THIS__ .DAY OF ..���-� -.19155.. NEW HOUSE`SEWER tyw�:✓,� l.:(�
OWNER OR _ ' J CONNECT ADDITIONAL -
OWNERS AGENT (� __ BUILDING OR WORK
SEPTIC TANK,SEER PITS) -
ADDRESS _....... � .�. ..��..L1... .}.J.���j. PND/ORARAINFI ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ TTIHIS APPLI. CESSPOOL E] DRYWELL Q
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 IAM PROPERLY REGISTERED' DISCONNECT PLUG AND
AND/OR .LICENSED AS REQUIRED BY;LOS ANGELES COUNTY DISCON ECT HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER.OF.THEABOVE DESCRIBED, ESIDENTIAL'PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S) CESSPOOLS
OF PERMITTEEWI. l_:. ._
76A642A 663 7/53