HomeMy Public PortalAbout8945-8947 EMPEROR AVE_Sewer__ t_� I
APPLICATION
® {p� PERMIT��c(p g��/p�
8&E 863 3 3S �fi
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY L/ � �e
FOR APPLICANT TO FILL IN NEAREST
LEGAL W W,47•GeT� _
DESCRIPTION ��``LOK/ NO y� f� OWNER
BLOCK r�#T GC /IYC�Jb U. �Y"" MAILNO
SIZE OF LOT NOWOONBLOTS ��• CL
USE OF
BUILDINGS DISTRICT NO GROUP MAP
/ BK PG
NPL- CONNECTION DATA y�
NSTATION f.,L-,Co n DEPTH i
❑ STATE MANHOLE REFERENCE .�{ /�/ _J UPPER
REGISTRATION NO ❑ COUNTY ✓ A.""Pe'
NO DESCRIPTION OF WORK FEE
TYPt O CONNECTION LENG4 FROM
HOUSE SEWER CONNECTING TO --�. Y CURB /P'L'C M L P L67
PUBLIC SEWER Q $ 3 50 v
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR P C NO
_ WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRAC WITH THE %kTl NAMED CON-
TRACTOR TO CONN T OVE DESCRIBED E) TING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC S ,,.►
SIGNED THNEW HOUSE SEWER
IS } DAY � 1 _
OWNER 0 / CONNECT ADDITIONAL
OWNERS T 1 BUILDING OR WORK
ADORES , SEPTIC TANK, SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL E:1DRYWELL C1AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THEi' L OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED ESIDENT I ROPERTY -- _
j / BACKFILL
SIGN A rr� i�!/` J //Ii�J � CESSPOOLS
M TEE
WAM J. FOX.COUNTY E GINEER VALIDATION R.A WOOD, CHIEF PLBG. INSPECTOR
AC 9 4 4 71, OCT 2,'7 4 Q,5 fl-) tO
/1-44-t-7 i/