HomeMy Public PortalAbout9047 EMPEROR AVE_Sewer__ F
663 12 34 D APPLICATION FOR PERMIT 1
-'6S&8 E 6DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of LOB Angeles DIN qyj
'ADoaE
WM.J FOX, COUNTY ENGINEER
` CASSATT D GRIFFIN, SUP T of BUILDING LOCALITY /��
FOR APPLICANT—TO FILL IN NEAREST '
CROSS ST
LEGAL / l
DESCRIPTION LOT NO ( (,1r�)I�) I, OWNER oil ,
BLOCK TRACTMAIL
ADD ESS
NO OF BLDGS I
SIZE OF LOT NOW ON LOT �1,( TEL N 'J
USE OF /
BUILDINGS ,e' / ' �"� r / v DISTRICT NO GROUP MAP
BK PGS
CONTRACTOR �� <
AD ESS,v h --r'�e!"'��- vLe CONNECTION DATA
i
CIT TEL r �i � STATION DEPTH
U-:kTE MANHOLE REFERENCE
REGISTRATION NO /'� ❑ COUNTY .LOWER
G� TYPE OF CONNECTkOR LENGTH F M
NO DESCRIPTION OF WORK FEE Y CURB P Ll M L TO P
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 ef
CONNECT ADDITIONAL BLDG OR CO IMP NO „ JOB NO
WORK TO HOUSE SEWER 1 00 7 V
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 DRAI NFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
5-ECTAL CONDITIONS ONLY 2 00 CHAR S
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
HAVE ITRA CTORTHIS
DATE CONNECT THE ACTED ABOV EWITH THE HERIDESCR BED EX ESTINGAMED DWELLINN.
G G APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SE ER _
SIGNED THISDAY OF �yW HOUSE SEWER
Y�
OWNER OR CONNECT ADDITIONAL
OWNERS A. ENT ri BUILDING OR WORK
ADORE �' - AND/ORTANKDRAINFSEPTIC , EIELD EPPIT(S)
1 HEREBY ACKN WLEDGE THAT I HAVE READ/HIS APPLICATION CESSPOOL❑,DRYWELL[IAND STATE THAT THE ABOVE IS CORRECT A �DGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATEWS 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 1 AM THE LEGAL OWNER OF HE ABOVE
DESCRIBED RESIDENTIAL PR TY Q
BACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS J"t
SIGNATURE �qI
OF PERMITTE
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION
BY
D
45
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DEPUTY 7 5 �Y FJ SEP 4 DEPUTY
BY BY
® 1 DEPUTY DEPUTY