HomeMy Public PortalAbout5013 DOREEN AVE_Sewer__ DF.PARTW]NT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL'
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENDINEER II gODRESS
FQ11 APPLICANT TO FILL IN LOCALITY
BUILDING 5�D j 3 Do Ree'll A ve FRossST.`
ADDRESS f� r
LOCALITY TC-M P L E C � T Y DISTRICT NO. SERIAL NV PERMIT NO.
NEAREST
ST. L D Wer 1Q" ..S uJs A 2�. 1 A /� 67/CROSS
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER 6: e,0 e ,L I a y0
MAIL USE ' OCCUPANCY MAP
ADDRESS S E ZONE'
BK PG
` CITY TEL—no,-3 A— /
!- Z� -' / •�n /( 3�
CONTRACTOR CO.IMP.NO.
ADDRESS JOB.NO. •
CITY TEL TRUNK PERMIT NO.
REGISTRATION NO. 71 1,7" B COUNTY ROAD PERMIT NO. Z$4
LEGALION -LOT N0. / STATE ENCROACHMENT
DESCRIPTPERMIT NO.
BLOCK C TRACT j 1 ';2„ 90 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 80 X r 97 NOW ON LOTS 1 CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE _ REIMBURSEMENT FEE /
HOUSE SEWER CONNECTING TO t
PUBLIC SEWER a $ 3.50 ':� -RECEIPT` N`` /DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONALBLDG.Ofl a EXCEPTION RECORDED
i— WORK TO HOUSE SEWER 1.00 �— NO
ALTER OR REPAIR EXISTING DAT 6Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR t "' /
PITS AND/OR DRAINFIELD 2A0 STATION/ yv 1 S DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / , 6 / f MANHHOLEREFERENCE' .LOWER
. TYPE OFCURB CTIONM1r ME`GTOHPFROM Q /
OWNERS rEeMrc S 21 DD
AUTHORIZATIONI HAVE DATE CONTRACD WITH THE HEREIN NAED
TOTAL FEE SO
CONTRA T01R TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER��AA ,,��
SIGNED THIS--*„ --,--DAY OF...21,1 L........_.-.19_4 NEW HOUSE SEWER
CONNECT ADDITIONAL ,
OWNER OR BUILDING OR WORK
OWNERS AGENT..-!-._ ._:._.. ._- .. -
/r.. 1� - SEPTIC TANK,SEEP.PIT(S)
ADDRESS-----1.J..Q_L3...--.� '.�—��lwat.------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL Q DRYWELLQ'
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY -”
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RES[ FIAL PRO(IERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)Q-_;CESSPOOLS
OF PERMITTEE--- -- - ------ -- -- - �--- -- -- _...- .-_- --.•.. - -
76A642A 663 7/53 ,