HomeMy Public PortalAbout4948 DOREEN AVE_Sewer__ DF:PARTbiENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I AUILDING
DDRESS y�yf 1�41'
FOR APPLICANT TO-RLL IN LOCALITY Y �,
BUILDING NEAREST
ADDRESS 9�f" te "P/ CROSS ST.
LOCALITY DISTRICT NO, SERIAL NO. PERMIT NO.
��NEAREST . -
CROSS ST. Pi RR EECCEEIY. 'BY O Ready for Inspection /OAT ISSUED
OWNER /rJA. �////// •' l// l�j+ . FJ J�_y
AHUSE ZONE/ OCCUPANCMAP
( ESSL/.�f. � //YJNf�/LL Y RK PG
CITY /�,"�j��%•UjTEL.NO. / I �E's ��
�. //
CONTRACTQR7�/��/-•�f�/�7. CO.IMP.NO. j 2 Z '�/T
ADDRESS /^ Ty�. � ��
_ C/• ��1' ��7� JOB.N0.
CITY �O/� 07V/TEL.NOl� /J�3/�� TRUNK PERMIT NO.
REGISTRAT N0. d' dg��0ed'p* SOUNTV ROAD PERMIT N0. 2 7LEGAL
3
DESCRIPTION LOT 110f�Z JQ (O sIX / STATE ENCROACHMENT —�
PERMIT NO.
BLOCK TRACT /,1,2 .PQ USTRIAL
WASTEAPPROVAL
SIZE OF LOT ��/�/3S NOW ON LOTS f CHARGES" v G
_USE OF
BUILDINGS f/' ✓�,�C,�i CONNECTION CHARGE4E
/(-� C/
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE I�
/ HOUSE SEWER CONNECTING TO
PUBLICSEWER 0 3 3.50 RECEIPT NO. \DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIONIkECORDED
WORK TO HOUSE SEWER 1.00 /NO. OAT€ IBY
ALTER OR REPAIR EXISTING \
S EWER 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 /O 7"S;7� Q DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 // /, r NIHOOLLEBREFERENCE LOWER
TYPE OF NRECTION LENGTH FROM -1 L�
OWNERS PERMIT $ I I DO as cufteJ .P� M.L.TO P.L,
AUTHORIZATION I TOTAL FEE {-`;r !:
I 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
SIGNED THIS_......./... _ AY OE...:TU -.PL..—_..1 NEW HOUSE SEWER 1j
OWNER OR
OWNERS AGENT, �_ �.� .......
CONNECT ADDITIONAL
......_. BUILDING OR WORK
N. ^.�:J.� G.'�rf!='-J.y.,....__. SEPTIC TANK,SEEP.PIT(S)
AGGRESSI
....._.._._........__. AND/ORORAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN• ABANDON HOUSE SEWER
- �8 / BACKFILL SEPTIC TANKS
11
ER OF THE ABOVE DESCRIBED R F ENTIAL PR P SEEP.PIT(S)E] CESSPOOLS
SIGNATURE
OF PERMITTEE ....._.. ... ._.L ...�._!�___.._..._._..._..
76A642A 663 7/53