HomeMy Public PortalAbout4814 DOREEN AVE_Sewer__ DEPAIVT511ENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING p ,/
' ADDRESS
FOR APPLICANT TO FILL'IN LOCALITY Te + is /E
BUILDING ps j / '�
ADDRESS ' tZ9� ��.rYy�LJY' / p'C. CROSS ST. Nahff'I' O / L/ wef .•74diS
LOCALITY P,, �//�t �f�'✓ DISTRICT NO. SERIAL INO. PERMIT NO.
NEAREST /• .A S
CROSS ST. .[Old' ir/ ,✓�3!//+aP �,� . REG IV^ED BBV Ready for Inspection DATE ISSUED
OWNER GtlrP�T<'✓� f/ �.0/,s</fr/f' val.t.�
MAIL f'
A'ORESS 7��Y�Q_ DO/T'Efr t/ �JUB USE ZONE OOCCUPANCY SK MAP PG
CITY Y�f/�E-E C+/Tr TEL.NO.
CONTRACTOR ��✓/Y r CO.IMP.NO. 13 /
ADDRESSlJ��!//➢f'� / yL' •� JOB NO.
CITY /TEL.NO. �d'IY3
TRUNK PERMIT N0.
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO. 231 T./-2
LEGAL ,SA'r 3G ' LJT d"i� Z
DESCRIPTION LOT NO.&sy Ia //py b� STATE
NO.
ROACHMENT — „
BLOCK TRACT /3E,4vsj INDUSTRIAL
�T WASTE APPROVAL
NOW -rte^
SIZE Of LOT.SSS ON LOTS eI CHARGES
USE OF
BUILDINGS /QI$,s//JLiVCS )t 6�/1�y�� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO' REIMBURSEMENT FEE •'-" ���"' -
PUBLICSEWER Q $ 3.50 O RECEIPT NO. `I i.
DATE 16�
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 OO
ALTER TE OR REPAIR EXISTING , NO' DA , BY
SEWER OR DISPO SALSYSTEM 1.00 --I— —
"DISCONNECT AND ABANDON SEWER -
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA -
SEPTIC TANK,SEEPAGE PIT OR [''
DEPTH
PITS ANO/ORDRAINFIELD 2.00
CESSPOOL—DRYWELL STATION 1 � ,�••.Et
A
SPECIAL CONDITIONS ONLY 2.00 / ^ � � / ANHO�LE REFEREENC r LOWER
TYPE OF CONNECTION LERGTH FROM /
OWNERS PERMIT $ 1 00 CURB —R.L_ M.L.TO P.L. 3O
AUTHORIZATION I TOTAL FEE cY� SCJ
I HAVE THIS DATE CONTRACTED WITH THE'-HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS ; INSPECTOR'S SIGNATURE DATE
LL_
SIGNED THIS.� l.
.. ._ _l...L:�._DAY OF... _.------_ ----.103. NEW HOUSE SEWER
OWNER OR r _ - BUILDING ADDITIONALCONNECT
ADDRESS_
OWNERS AG[�E f.:.. � a. 1' • -
TA SEPTIC TANK.SEEP.PITS)
AND/OR ORAINF.IELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPCI- CESSPOOL 0 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
1„HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BVACS ANGELES COUNTY AND
.ABANDON HOUSESAND
AND STATE OF.CALIFORNIAAR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTICTANKS,E]
SEEP.PIT(S)E] CESSPOOLS
SIGNATURE :- � ”
OF PERMITTEZr � ? ' {Vi.. ._......
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