HomeMy Public PortalAbout4825 DOREEN AVE_Sewer__ J
t DEPART31ENT OF COUNTY ENGINEER SEINER-SEWAGE DISPOSAL
bI-V;SIGN OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
'.Y �,\ A^
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS ��,�'� "` .�1"'EpY� K
FRESS
OR APPLICANT FO FILL IN LOCALITY =�—,
BUILDING n! NEAREST
S „[�J '� . ��,(�(/L{� Q+�.-�/ CROSS BT. /.nk ,V p1 �7 l i G�d�
Y DISTRICT N0, SERIAL NO. PERMIT NO.
.APDL a Pi
T- ��••��
. % " Nn /l// /.�-r'r LRECEIVED BY Ready for lnroaotion {DATE ISSUED
1S' � _MAIL
USE ZONE OCCUPANCY MAP
TELNO. �, � BK PTOR •. 'l, %/l l-fN.�i..,�r CO.IMP.NO.
ADDRESS'� 'L�J /f�� M GZ'(p.Q,r JOB.NO.
CITY TEL.NO. ' /0./� ?a_TQ
�1 TRUNK PERMIT N0.
REGISTRATION NO.��...) p��/ (�� ��r STATE ROAD PERMIT NO.
LEGAL ��
DESCRIPTION LOT NO. STATE ENCROACHMENT,PERMIT NO.
BLOCK TRACT / �/�O INDUSTRIAL
WASTE APPROVAL
NO.OF BL
SIZE OF LOTS-3 ( 6 NOW ON�LLOOSS CHARGES
BUILDINGS/��'Q. r!/�/ltr /'O CONNECTION C GE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER 0 $ 3.50 RECEIPT NO. DA BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR / EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE IBV
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 �_ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 F STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 NHOLE REFERENC
UPPER LOWER
OFCONNECTION LENGTH FROM
OWNERS PERMIT S I 00 CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I OQ
1 HAVE.THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER n '_,,•.D
SIGNED THIS------- OF...... 19;_ NEW HOUSE SEWER
OWNER OR "c� � / CON NECT ADDITIONAL
�' y.�ey�•���, eU1LDING OR WORK //(U/✓I^�.M••f/ /,1���./.
OWNERS AGENT...s..e:Y.Y..! ......_.._.._......_.._._.._._....._._
L, ?� N ��/� SEPTIC TANK,SEEP.PIT(S)
ADDRESS......Y....__....__...G.�s.....__.. ......_.............r5.,._..t:.A-. AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE 18 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 I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN• ABANDON HOUR SEWER
ER OF THE ABOVE�DDESSCCRRIBED RESIDENTIAL PROPERTY..O BACKFILL SEPTIC TANKS E]
I-SIGNATURE .7. / /— 1� �/uy,� , '�, „rvy SEEP.PIT(S)Q CESSPOOLS
OF PERM ITTEE< �YC(Ly�/ �`7"`�Y`� `..*
7GA642A 663 7/58
1' DEPART31ENT OF COUNTY ENGINEER % SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES '
WILLIAM I.J. FOX. COUNTY ENGINEER I BUILDING
ADDRESS ;185 /1N G7G;,4x'FN
F..O/p` APPLICANT • O FILL IN ) LOCALITY
BUILDING8�-SN' �!•O ,/-r /\j CNEAREST
ROSS ST. LDI/LER �I.Z//SA
ADDRESS / 7(y f-/R+/��j/V/
LOCALITY e DISTRICT N0. SERI/AL NO. ppPERMIT NO.
NEAREST ✓� •SCS A /G(p�,� 1ir.6�3 S
CROSS ST. RECEIV EO BY Reedy for Inspection DATE ISSUED
OWNER .I ��/ 7 2T•-.J..3
MAIL
ADDRESS �Y1� V
J USEZONE OCCUPANCY MAP
BK PC
CITY TEL.i O. ll?ES
CONTRACTOR CASL-LS�L�rP CO.IMP.NO.
ADDRESS
JOB.N0.
CITY TEL.NO. TRUNK PERMIT NO.
_REGISTRATION NO. /'/1 �'� STATE /�
LEGA__ `ROAD PERMIT N0. 24 /�,
,/ f �/ STATE ENCROACHMENT r-L y�-
DESCRIPTION LOT N0. N. -3 I Qj� Q1;/' 7 PERMIT NO.
BLOCK TRACT3" INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT5 3 •' , , _ NO.OF BLDG$.
NOW ON LOT CHARGES
USE OF / �+ \
BUILDINGS i J CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S 3.50 1 RECEIPTNO. I DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ..1.00.
CONNECT ADDITIONAL BLDG.OR - - EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NOI DATE IBY
_SEER OR DI SPOSAL SYS
WTEM I.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR p
PITS AND/OR GRAINFIELD 2.00 STATION �f �/ DEPTH
CESSPOOL—DRVWELL
SPECIAL CONDITIONS ONLY 2.00 S S� MANHOLE
UPPER LOWER LOWER
TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT" S 00
/
-Y.— CURB / .P:L M.L.TO P.L. 3O
� I
AUTHORIZATION TOTAL FEEL,l $ G
1 HAVE THIS DATE CONTRACTEDWI
TH THE HEREI NAMED
CONTRACTOR TO CONNECT THE A VE THE
EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER II'
SIGNED THIS___�.L.. .DAY OF.. .........
_..... .. 19 NEW HOUSE SEWER , , 724
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTBUILDING OR WORK
� - SEPTIC TANK.SEEP.PIT(S)
ADDRESS......_... ._ . ....... ... .. .. .. . AND/OR DRAINFIELD
I HEREBY A N LEDGE THAT I AVE EAD THIS APPLI- CESSPOOL E] ORYWELL ll
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
AN LICENSED AS REQ IRED BY L08 ANGELES COUNTY- DI6CONNECT PLUG AND
DSTATE%JOS
ll HAT I AMTHELEGAL OWN• ASANOON HOUSE SEWER
R OF THEE SI DENTIAL PROPERTY BACKFILL SEPTIC TANKSEP.PIT(S)E] CESSPOOLSIGNATUREF PE RM ITT -... .. -.... ._.......
YGA642U G63 I/53 _ _ - 07