HomeMy Public PortalAbout5100 DALEVIEW AVE_Sewer__ ?ErAKTLN
MENT OF COUNTY ENGEM SEWER—SEWAGE DISPOSAL3491 1
D VISION OF BUILDING AND SAFETY PERMIT APPLICATION g
• � COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESSBUILDING SjOO [/may-yy�/�r N/
FOR APPLICANT TO FILL IN LOCALITY
ABUILDING DDRESS 5 100 Ddlview NEAREST
CROSS ST. D
ArIc—
LOCALITY El?4onte DISTRICT N0. SERIAL N0. PERMIT NO.
NEAREST II n „ n _ A 7J-O�j s
CROSS ST.
RECEIVED BY Ready for IasOectl.n DATE ISSUED
OWNER John Hay- V-30
MAIL Slj EZOyE OCCUPANCY MAP
ADDRESS sam�+ iqi-'/� FIR PG
CITY TEL.NO. b� tto
CONTRACTOR California Sewer Const.Co_ GD.IMP.No.
ADDRESS 1317 Colegrove Ave. JOB NO. --
CITY Montebello TEL.NO.UNion 1-5048 TRUNK PERMIT NO.
jj]] $TATE
REGISTRATION NO. 104445 S7�$7,/�y NTY' ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. A7 PERMIT NO. --------------
BLOCK
—BLOCK TRACT`���... O I INDUSTRIAL
�� � WASTE APPROVAL
SIZE OF LOT O.OF BLOTS. l
OW ON LOT
NI CHARGES
USE
BUILDINGS Rea CONNECTIO! RGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURS EMENTFEE
1 HOUSE SEWER CONNECTING TO 0
PUBLICSEWER @ $ 3.50 RECEIPT NO. 1K BY
HOUSE SEWER CONNECTING TO
PRIVATEDISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER LOD .
ALTER OR REPAIR EXISTING N0I DATE IBY
SEWER OR DISPO S ALSYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PITON
PITS AND/OR GRAINFIELD 2.00 STATION ��..•3� DEPTH GI
CESSPOOL—ORVWELL
SPECIAL CONDITIONS ONLY 2.00 I MANXOJ.E REFERENCE
LL¢P.CS LOWER
TYPE OF CON ECTIONNGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. ' M.L.TO P.L.
AUTHORIZATION TOTAL FEE 4.50
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDI
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TOT E UBLIC SEWE jjjyyyb��`��- G
SIGNED THIS..... .....DAY OF... . ---------19..G NEW HOUSE SEWER
OWNER OR AJ/1M _. _. _ ._
CONNECT ADDITIONAL
OWNERS AGENT..._.. ...IIV!!...--- _ BUILDING OR WORK
j ��� __ SEPTIC TDRAINFEP.PIT(S)
ADDRESS..............._ ._..... . . ..... .. - AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ H`rf IS APPLI- CESSPOOL E] DRYWELL
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 1 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 DIESCH BUD ESIDENT1IAL P�RO7P}E�RTY, BACKFILL SEPTIC TANKS ( ,./ •,/
SIGNATURE . ,/I` -��s ^ '/J r _ I SEEP.PIT(S1� CESSPOOLS
OF PERMITTEE.. ._�. _._ '1!! ... - 1. t..'
761642A 663 7/53 4-01^