HomeMy Public PortalAbout4447 ELLIS LN_Sewer_3/23/1953_ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELES
6 WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS
FO PP ICANT TO FILL IN, LOCALITYBUILDIrn�/P
ADDRESS
� � � /�� A NEAREST { �. .�� /1 ZLtj q x ,
ADDRESS TTT""" .r%� p� g' NEAR ST. �-GL(J fT �� l `i7
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.`7
NEAREST �/B �I / A -7 5b 4/333 S
CROSS ST.
RECEIVED BY' Ready for Inspection DATE ISSUED
OWNER ��r!�//ff _/
MAIL T 7 fes--//�✓/ L�+�/ i
ADDRESS USE ZONE OCCUPANCY MAP
- BK PG
CITY
CONTRACTOR �. � f/� s��j 1.•�® y CO.IMP.NO.
JOB.N0.
CITY ( / TEL.NQ-/ dp i TRUNK PERMIT NO. Tpk7y (4 2, C
(J >rAt
REGISTRATION N0. ❑ COUNTY ROAD PERMIT N0. � 3
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT G�e_? WASTE APPROVAL
INDUSTRIAL
SIZE OF LOT �/�T— N0.OF BLDGS.
NOW ON LOT CHARGES-USE OF
�,(
BUILDINGS �f/�G�/lee/ CONNECTION CHARGE FEE �Q�(U 75(1= /-/!;2M
NO. DESCRIPTION OF WORK FEE
_ REIMBURSEMENT FEE
IHOUSE SEWER-CONNECTING TO
PUBLIC SEWER - @ $ 3.50 I -3 .5� �R�ECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 / 0,0
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
SEWER OR DISPOSAL SYSTEM 1.00 N0.
ALTER OR REPAIR EXISTING I DATE I BY
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR.
PITS AND/OR DRAINFIELD. 2.00 STATION A�JJ�7)X G6 tG, DEPTH. /
CESSPOOL—DRYWELL /�
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REF�JEN
UPPER /J.- Off`- LOWER
_ /
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I .11
oo
Y. CURB P.L. M.L.TO P.L.
-
AUTHORIZATION TOTAL 'FEE I SU
1 HAVE THIS DATE CONTRACTED.WITH THE HEREIN' NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P BLIC SEWER
SIGNED THIS---- ---- ------DAY OF---:-..�r ---�.----...-.--......19.._ NEW HOUSE SEWER
�° ��
OWNER OR /1 9 - CONNECT ADDITIONAL
OWNERS AGENT. ........ . -- BUILDING OR WORK
o �y - � / � �a� //JJ✓✓" SEPTIC TANK,SEEP.PIT(S)
ADDRESS - :... AND/OR DRAINFIELD
• e,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] 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
I HEREBY CERTIFY THAT 1 AM. PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF. CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE VE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I
y��i� SEEP.PIT(S) CESSPOOLS ( 7�S
SIGNATURE C!' �j(� �, L- _ '�
OF PERMITTEE_.--------. _--5 ---lt-l.-lua/✓=!-G,d.
76A642D 663 1/53