HomeMy Public PortalAbout9048 EMPEROR AVE_Sewer__ &E C6D
6 63 12 54 APPLICATION FOR PERMIT 7
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles FAD
ING
WM J FOX, COUNTY ENGINEER SS
CASSATT D GRIFFIN, SUPT OF BUILDING ITYFOR APPLICANT TO FILL IN 17
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All-
LEGAL r
DESCRIPTION LOT NOy�. OWNE
MAIL
BLOCK TRACT I -�Jy' ADD ES
NO OF BLLDGS I � �
SIZE OF LOT NOW ON LOT T
OIC �_ � r `-�• O U
USE OF LI
BUILDINGS ,/ J �^ DISTRICT NO GROUP MAP
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S K PG
CONTRACTOR ESS
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ADDRESS, �� �@/ (' CONNECTION DATA
CIT /JDTTEL N ' STATION �— f�+ DEPTH /
MANHOLE REFEREN ✓ /6�yV t/
REGISTRATION NO ❑ COUNTY UJ�� . f/ LOWER
TYPE OF CONNECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE Y CURB �C'1 M L TO P L .S
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO IMP NO l 9 U f 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 DPAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHAR\s
CONNECTION CHARGE FEE
OWNER'S PERMIT g 00
AUTHORIZATION I TOTAL FEE - RF'MBURSEMENT FEE
TRACTORHAVE T TO CONNECT THEHIS DATE AABOVE DESCRIBED EXIISNINGAMED DWELLII G APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEW R
SIGNED THIS AY OF 19.E a W HOUSE SEWER
OWNER OR 1 CONNECT ADDITIONAL
OWNERS AGENT / BUILDING OR WORK
ADDRES � / ''J"f �' AND/ORTDRAINFEIELD PIT(S)
1 HER BY AC NOWLEDGE TMT I HAVE EAD THIS APPLICATION CESSPOOL❑_DRYWELL[IAND STATE THAT THE ABOVE 1 CORREC PND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND TATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS - SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL"OWNER OF TH ABOVE _�^
SE SEWER
DESCRIBED RESIDENTIAL R TY
SEEPFPIT(S)ILL P❑CCESSPOO - V
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BT - _1��07 6' B 7 7 SEP 9 4 4.5 b
DEPUTY + DEPUTY
BY � BY
® DEPUTY DEPUTY