HomeMy Public PortalAbout4832 DOREEN AVE_Sewer__ DEFAICTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL ¶
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION a
COUNTY OF/LOS ANGELES
WILLIAM J. FOX. COUNTY. ENGINEER BUILDING
_ ADDRESS 148 _
FOR APPLICANT TO FILL-IN Locaurr M rs n p
1 BUILDING NEAREST
ADDRESS CROSSST. 1-M L"e,- A7 I t.Q'3,-
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST `` X1723 S.
CROSS ST. T ,�
]]�RECEIVED BY - Ready for lnt0aallon DSA/TE LSSUED
OWNER [ •TJG. IP. _ %/GTySn
MAIL F
ADDRESS K- USE ZONEOCCUPANCY I MAPS
A BK PG
CITY TEL.NO. /41// 'G/l� / �f
CONTRACTOR I . /.32 - 2 4 h jf
CO.IMP.N0:
ADDRESS76 �t >rf �� -. JOB NO. 1
CIT �M9.(f yj TEL.NjY . IG�''Q TRUNK PERMIT N0.
REGO NO-7 �� -y� (- IJ COU/HTV ROAD PERMIT NO. tx�"L 2 —,el7ZY
LEGAL 46 . 5-s%-, STATE/
DESCRIPTION LOT ND. 6 yJ� ENCROACHMENT
_ PERMIT NO.
BLOCK TRACT fzai ��3 INDUSTRIAL
W
SIZE OF LOT N0.OF BL ,
NOW ON LOT
ASTE APPROVAL
/J�/J �` CHARGES
USE OF
SU ILDINGS gQ-pJ �r� /irt�l4J CONNECTION-C`ARGEFEE
NO. DESCRIPTIDI OF WORK FEE
HOUSE SEWER CONNECTING TO �( REIMBURSEMENT FEE /
PUBLICSEWER $ 3.50 Sd RECEIPT NO. DATE BV
HOUSE SEWERCONNECTING TO / \
P RIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR
WORKHOUSE SEWER 1.00 /XCEPTION RECORDED \
ALTER OR REPAIR EXISTING / NO' I DATE BY \
SEWER OR DISPOSALEXISTING
SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION.DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION �-'01- 2 DEPTH 4 /
CESSPOOL—DHYWELL
SPECIAL CONDITIONS ONLY 2.00 / //� !Oj%U PPE-REFERENCE
TYPE OF CQNNECTI 0�1�D LENGTH FROM �^ /
OWNERS PERMIT ; I 00 �? �CUeD'7 �i M.L.TO P.L. -
AUTHORIZATION TOTAL FEE —r
1 HAVE THIS DATE CONTRACTED WITH THE NEI I EIN NAMED
CONTRACTOR TO CONNECT THE ABOV DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.cS.�_...DAY OF. . 19, NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AG(E�NT</y./j__�//.1JA� t� .��'_R'SQe BUILDING OR WORK
ADDRESS.rL}.. .... �� G �., , q_ SEPTIC TANK,SEEP.PIT(S)
...._........._._..�...._e_..,i--f.._ —_..J AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 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 I AMPROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED REQUIREDBY LOS ANGELES COUNTY
AND STATE OF CALIFIFO NIA OR T B THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D RIBEWD ESIOENTIAL PROPERTY. BACKFILL SEPTIC TANKS E
SIGNATURE �
r<.c.F{_ � - SEEP.PIT(S)p CESSPOOLS[ G� A-(� A'I3'
571
OF PERMITTEE.. . '_�.."_.yyEE._�. .._._._... . 1'!:�.._.._......
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