HomeMy Public PortalAbout4833 DOREEN AVE_Sewer__ DEFARTAf]UgT OF COUNTY ENGIN= I SEWER.=SEWAGE DISPOSAL
` DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
A00 RE55
i
PPLICANT O FILL IN rr nn LOCALITY ✓C>�pL� G/TY
ADDRESS .BUILDREST
;3 , L U 6yl�& CROSS ST.
LOCALITY -Tf'-A1L'fq I F, c 17-V
Tv DISTRICTT NO. SERIAL N/0. rP,ERMIT NO.
NEAREST ) A /]� 5-do A �G�p//i //[ L9y S
CROSS BT. / /1�QWj C /l/`�-1 (,//s/� 17� RECEIVED BY Realy for Ineaeetion gDATEISSUED
OWNER /V1.1 (W ` J SIV F Y �]�r' /� /`1.�-c')�.'�
ADDRESS - 10 �Y Y USE 20NE I OCCUPANCY PANCY BK MAP PG "
CITY .'TEL.NO.
CONTRACTORr"yls: _4tl4e_/7 rlo-m'irrl) CO.IMP.NO.
ADDRESS/-? 7 --P , IOB..NO.
CITYSEL.NO. ❑ TRUNK-PERMIT-NO,
REGISTRATION NO. /�� ` / ❑ COUNTY ROAD PERMIT NO. 4LEGAL
DESCRIPTION LOT N0. S,/// "3 S�o��Ft 48 r/- N./�.� STATE ENCROACHMENT
- l PERMIT NO.
BLOCK TRACT 4,( DA /0 4 7 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO.OF BLDGS.
5?i NOW ON LOT C CHARGES ^
USE OF
BUILDINGS ( ,1 CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEEy, REIN BURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
-.PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED, -
WORKTOHOUSESEWER - - 1.00
ALTER OR REPAIR EXISTING NO' I DATE BY
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 DRAINFIELD 2.00 STATION �'2L 0� DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00. p• /y��M,A NIHROPLEERREFERENCE SLOW ER
TYPE OF CONNECTION LENGTH FROM
OWNERS I PERMIT SI oo ``" CURB / -P1. M.L.TO P.L. 3D/
AUTHORIZATION,- -TOTAL-"FEE I U
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE A VE DESCRIBED EXISTING' 'APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH PUBLIC SEWE
SIGNED THIS.__.�1...DAY OE:. .. ----------_------ "xew HOUSE sewER,;
OWNER - OR CONNECT ADDITIONAL - -
OWNERS AGEN �, _ .-"_.... .. ............._ ......
BUILDING OR WORT(
SEPTIC TANK,SEEP.PIT(S)
ADDRESS___.._-_ ____-_ .. ------ ANO/OR GRAINFIELD
-I HEREBY ACKNOWLEDGE,THAT 1HAVE READ THIS.APPLI- CESSPOOL E] ORYWELLE]
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. - ALTER.REPAIR,
DISPOSEWER R
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED SEWAGE
AND
AND/OR LICENSED AS REQUIRED BY .LOS ANGELES COUNTY -ABANDON HOUSE SEWER
AND
AND STATE OF CALIF RNI OR HAT I AM THE LEGAL OWN-
ER OF THE ABO SCR ESIDENTIAL PROPE TV BACKFILL SEPTIC TANKS
SEEP.PIT(S)Q CESSPOOLS
SIGNATURE
OF PERMITTEE -_.__ .__ ..^'...... .... ._ ... ... ." .......
76A642D 663 ,`1/53