HomeMy Public PortalAbout4811 DOREEN AVE_Sewer__ DEPAUTMENT OF COU= ENGINEER SEWER-SEWAGE DISPOSAL .1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
�. COUNTY OF LOS ANGELES
f WILLIAM J. FOX. COUNTY ENBINEER I BUILDING . � l r�ri
ADDRESS
LOCALITY
jR� APPLICANT TQ FILL IN -1- C
BUILDING / yti0 NEAREST
/ (�i4w� CROSS BL LC Weq(_
LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO. �•
NEAREST s A 18 1 2 I S
CROSS ST.
InW k, (,RECEIVED BY - Ready for Inspection 1 0 TE ISSUED
MAIL /l ne ' • --
ADDRESS rJ"� XilW/���j USE ZONE IE OCCUPANCY IRK MAP PG
CITY I.,NA� TEL.NO.
CONTRACTOR / s A� � I. O.IMP.NO. I Z I Z
ADDRESS / JOB NO.
CITY TEL.MO.q Q},�. ❑� p TRUNK PERMIT NO.
STATE
REGISTRATION NO. 3 0 ❑ COUNTY
ROAD PERMIT N0. a 41 4
LEGAL _ (�h STATE ENCROACHMENT
DESCRIPTION L 0 T NO. PERMIT NO.
BLOCK TRACT J/ INDUSTRIAL
a f WASTE APPROVAL
NO:OF BLOTS.
SIZE OF LOT �J
/�7-SN'OW ON LOT
CHARGES
BUELDI NOS /�yy�,( � IlD/I,�(F'IP.....G.C, CONNECTION CHARGE FEE. /
NO. DESCRIPTION OF WORK FEE �.
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEES
PUBLIC SEWER S 3.50 [SZ7 RECEIPT NO. MOATIBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 \
CONNECT ADDITIONAL BLDG.OR Q EXCEPTION RECORDED
WORK TO HOUSE SEWER - L00
ALTER OR REPAIR EXISTING ' NO. 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
PI TS AND/OR DRAINFIELD 2.00 STATION 1 -+��• 'DEPTH /
CESSPOOL- DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ' ERECE
i 4A �
LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 cuss =Y-1,E} M.L.TO P.L.
AUTHORIZATION TOTAL FEE. ll�_
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING-
DWELLING TO THE SEWER��11 APPROVALS INSPECTOR'S SIGNATURE DATE
i-
SIGNED THIS---o'iC1/_�.....DAY OF---.:!d.h:'=.__.__._._._--19_0 NEW HOUSE SEWER
OWNER OR � (O ����� CONNECT ADDITIONAL
OWNERS A//G//ENpT..../.._.. ._.._.....)..__........._._.._........:...M�=-C_......... BUILDING OR WORK
SEPTIC
ADDRESS..7...R. ....S.C�.<_.0- _�e..�,C.._....._.-.,..._-�L....... AND/OR DRAINF EL0 ITIS)
LAND/OR
EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL Q DRYWELL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE
LY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
TING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
EBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT.PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTYATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN• ABANDON HOUSE SEWER
HE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKSSEEP.PIT(S)0 CESSPOOLS Soh nGRE �// 'M ITTEE..._. .. � ^._. -. - _�A.Sa.._._. -
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