HomeMy Public PortalAbout5138 DALEVIEW AVE_Sewer__ T6AG420 APPLICATION FOR PERMIT
9 6 E.663 3-35
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engleeer .' ...
County of Los Angeles emLDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
® CASSATT 0. GRIFFIN, SUPT OF 6UILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT Q MAIL
ADDRESS
T NO. OF BLDGS.
SIZE OF LOT NOW ON LOT / CITY
USE OF
BUILDINGS li" 1 l/ DISTRICT N0. GROUP MAP
�I L
PK PG
CONTRACTOR CALIF.SE4JER CAIJST.C4. vl.,
ADDRESS IM7 COLEGROIJE htO AV�.�t /7 A CONNECTION DATA//
CITY ITEBELLOTEL. N0.PA, 1_5C48 STATION /.-� Al O DEPTH 46 ,
' \ ❑ STATE MANHOLE REFERENCE�J/ ��� O�
REGISTRATION NO. 1QV OJpccp J (STATE) [I COUNTY —j
No. DESCRIPTION OF WORK FEE r� '_
HOUSE SEWER CONNECTING TO sdG TYPE OF CONNECTION LENGTH FROM ay ` I
PUBLIC SEWER Q S 3.50 -�� �' `. M.L. TO P.L. ei•e�+
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. ND.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE END RO ENT
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD .00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 /HARG
PERMIT CONNECTION CHARGE FEE
OWNER'S S o0
AUTHORIZATION I
11119URS EM ENT FEE
I HAVE TY�iIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR 70 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE,
TO THE PUBLIC SE\VE
SIGNED THISNEW HOUSE SEWER
OWNER 0D O —1
�/J CONNECT ADDITIONAL
OWNERS A BUILDING OR WORK '
ADD LZ/ SEPTIC TANK, SEEP. PIT(S)
AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR _
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ,
LICENSED AS REOUIRED Y LOS A ELES COUNTY AND STATE OF ' DISCONNECT PLUG AND
CALIFORNIA OR T
JY
AM TH L AL OWNER OF THE ABOVE ABANDON HOUSE SEWER _
DESCRIBED RES 1 PROPE Y. BACKFILL SEPTIC TANKS C
SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE �,��J,j,{I.�� G�
OF PERMITTEE / L //
_ 0%t! f o /i//
WILLIAM J. FOX, COLNTr CAGILISIZIZIR VALIDATION R.A.WOOD. CHIEF PLEG. INSPECTOR
I_ACo4 7 6 1 APR 4 4 4.5 0 ,r