HomeMy Public PortalAbout9854 ESTRELLA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELES
J WILLIAM,J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS
FOR APP,L/ICA5N'T^TO-F�ILLn IN LOCALITY
BUILDING `pj�S��T L��/� (il.� CROSS ST. .
ADDRESS //�S
LOCALITY ' (�� r ' DISTRICT NO. SERIAL NO.. 9 ,r%PPERM TT NO..
JA
NEAREST'"f? _ n /J - audc- � - //'�= RECE VED V Re�y for Inspection UA ISSUED
63
CROSS ST.�'I��..JJ��C[X 11i�l'Lnf.Cry✓L .Y1.. -�Y
OWNER l�•/� YYIF/rfN �( - r
MAIL C ,„ -_^ p USE ZONE OCCUPANCY MAP•7
ADDRESS JCf�'�" `-�-^
BK PG
CITY _ TEL.NO.4a,(_Q/Qjj�TyyG��/ ��
CONTRACTOR ,.Q.C.C(✓y�W�'Y� 0,IMP.NO. /,3�QZ. �S/7 ✓ � �
ADDRESS (p 013 'JOB.NO,
CITY � �/V(/(/ L;�(�( 'EL.NO.� 7� I TRUNK PERMIT NO.
� �/ STATE
REGISTRATION NO. !ll��� COUNTY. ROAD PERMIT NO. q -3
LEGAL
DESCRIPTION LOT N0. / /J STATE ENCROACHMENT
7 PERMIT NO.
t
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT pOW ON LOTS / I CHARGES
USE OF
DI /I n . 4 I
BUILDINGS w 'L�'..([�✓yl. CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE I REIMBURSEMENT EEE "__ --
HOUSESEWERCONNECTING TO yh,
PUBLIC SEWER $ 3.50 V RECEIPT NO. I DATE IBy
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
WCONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
ORK TO HOUSE SEWER IAO N0. I DATE IBY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM . 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION 7,L DEPTH
SPECIAL CONDITIONS ONLY 2.00 F
r,2' A / MANHOLE EflENCE 1,/, 461 LOWER
•7 TYPE OF CONNECTION LENGTLH�FRO
OWNERS PERMIT $ 1 1 00 1 "Y. CURB J„e.L- M.L.
AUTHORIZATION TOTAL FEE 1O
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
S i ��/M-Q— NEW HOUSE SEWER
SIGNED THIS_._........_......DAY OF............_....._.........._.......195-.
OWNER OR ))�� � ,, /J `-?.y CONNECT ADDITIONAL U
`�r/Wf0 . —?.yl
Q,' l['/:tit 'BUILDING OR WORK
OWNERS AGENT __.._.._....__......_.._.._.:.._...._...._-----._......_._......�
SEPTIC TANK.SEEP.PIT(S)
ADDRESS...---------..._..._.__.._...._....__..._.._.. ------------_..__----...._/. ARD/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL(] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE AB EE D� RESIDEN IAL PROPERTY.<� CKFILL SEPTIC TANKS / GG
le;EP.PIT(S)� CESSPOOLS �i GH'YD CyC �f�;/s r'
SIGNATURE n ����^�
OF PERMITTEE .__._,y�.. ._ _c_.._ T,,....�..._....._../....
76A642D 663 1/53
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