HomeMy Public PortalAbout9018 EMPEROR AVE_Sewer__ A ®A ■�q+_ap ■p�� p�..y( PERMIT � 7
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DIVISION OF BUMDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deponent of County Engineer
County,of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS I
CASSATT D. GRIFFIN, Sur'T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. '
LEGALJ�n
DESCRIPTION LOT NO. e 1(�(/ OWNER
BLOCK TRACT [ MAIL
ADDRESS
SIZE OF LOT 1110119NOW* NO. OF BL ON LOT
DGS. CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NO GROUP MAP
CONTRACTOR CALIF. SENDER CONST.CO. C/ SK PG
2 Al
ADDRESS 1317 COLEGROVE AVE. CONNE�CCTTION DATA
CITY MONTEBELLO TEL. NOPA. 1-5048 STATION DEPTH ��•'
❑`STATE MANHOLE REFERENTS,
REGISTRATION NO. 148659 (STATE) ❑ COUNTY UPPER '.J. `_� "hy LOWER
_ TYPE OF CONNECTIO LENGTH FROM .1:..
No. DESCRIPTION OF WORK EEE Y. CURB M L. TO P L
HOUSE SEWER CONNECTING TO O
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG. OR 0 O CO. IMP NO, / 0 / JOB NO.
WORK C HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT N0. 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 CONDITIONS ONLY 2 00 CHA ES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 00
AUTHORIZATION' I TOTAL FEE REIMBURSEMENT FEE r
TRACTORHAVE TTOS CONNECT DATE CO
ONNETONTRTHEA A13OVECTED WDESCR BED EX STINGITH THE HEREIN A DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC W R �Y r O
SIGNED THIS DAY OF 19.E NEW HOUSE SEWER a /J/f/p
OWNER OR' �✓ CONNECT ADDITIONAL �/1J-�—
OWNERS AGENT �-• f. ✓..sl BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A,P CATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE T COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM r
I HEREBY 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 AM THE LEGAL OWNER.OF THE ABOVE '
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ 7
SEEP. PIT(S) ❑ CESSPOOLS -3P 3D
SIGNATURE
OF PERMITTEE i /
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION
_ACO7744n SEP 12 4 6.50
BY BY
DEPUTY DEPUTY y
ABY BY
` ® DEPUTY DEPUTY