HomeMy Public PortalAbout9002 EMPEROR AVE_Sewer__ 76A642D \P'\0 Y LI ATION, ■ OR PERMIT
S&E.663 12-54
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los-Angeles BUILDING •hy_ G� _ ,�
WM. J. FOX, COUNTY ENGINEER ADDRESS. CT /
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILLNEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO .i OWNER
BLOCK TRACT MAIL
ADDRE
NO. OF BLDGS.
SIZE OF LOT / NOW ON LOT
USE OF
BUILDINGS _ DISTRICT NO. GROUP MAP -
BK PG
CONTRACTOR �- `�• I .� �'
ADDRESS CONNECTION DATA
CI~ TEL. STATION / f-63 DEPTH
®'STATE D� MAN"'REFERENCE
Ji'f [IREGISTRATION NO 5-4 A COUNTY 11C'Tt LOWER
( (/ TYPE OF CONNECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE cCURB, PP L. M L.TO P L r
PHOUSE EWERUBLICS
EWER CONNECTING TO $ 3 50 \f L^ 4f—icr F�a� ��LJ/ X�
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO. IMP. NO. �` � JOB NO.
WORK TO HOUSE SEWER 1 00
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 2 00 INDUSTRIAL•
-
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDIl IONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE T TOS CONNECT ONTRTHEA ABOVE DESCRIBED EXCTED WITH THE ISTINGIN NAMED
DWELL NG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S�E ER
SIGNED THIS PAY OF J 1�9 EW HOUSE SEWER
OWNER OR �' BUILDING OR WORK
CONNECT AL
OWNERS EN
ADDRESS SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD '
I HEREBY ACKNOWLEDGE THAT I HAVE, AD THIS APPLICATION CESSPOOL[:1 'DRYWELL❑
AND STATE THAT THE ABOVE IS CORREC ND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES _AND A7E LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I A THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL. PERTY/� BACKFILL SEPTIC TANKS❑
G/ / J SEEP. PIT(S) ❑ CESSPOOL
SIGNATURE �/''�—�/�`'
OF PERMIT - -
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
iGo 6 � 2 :3 �� AUG y- n ; 0L
T.rJ V
y BY BY
DEPUTY DEPUTY
e BY BY
® DEPUTY j�Q� �°Y.t'�i'�d d'C��-. DEPUTY