HomeMy Public PortalAbout9180 FORTSON DR_Sewer__ DEPARTbIENT OF COUNTY ENGIN'EF.R SEWER—SEWAGE DISPOSAL 1
DIVISION O€_BVDING AND SAFETY PERMIT APPLICATION
COUNTY OIT' LOS AlgGELES
WILLIAM J. FOX, COUNTY ENGINEERI BUILDING �/ /)/� �� � � �)`
ADDRESS n yam/ 7
FOR APPLICANT TO FILL IN LOCALITY T ,,fy�0
BUILDING NEAREST )
ADDRESS yl kO /'0RTS6N �Q, CROSS ST.
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO.
TMPL � � ::5- n �� 7� 0 S
NEAREST [�
CROSS ST. En/G/I.1
/ ,a
EC
�/ RECEIVED BY Ready for Inspection DATE IIS/SUED
OWNER G'[fA/fLFS C3 C�JPAM�I�_ G a
MAIL `c M L USE ZONE OCCUPANCY BK WA —
ADDRESS `
CITY TEL.NO. _ '�!
CONTRACTOR M�^ CO.IMP.NO. 7 7
ADDRESS JOB.NO.
CITY TEL.NO. TRUNK PERMIT-NO.
STATE
REGISTRATION NO.
® COUNTY. ROAD PERMIT NO. a. 76 6— 51,
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT --�
y PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT / N0.OF BLOGS.
CO6R x 12h' NOW ON LOT CHARGES
USE
BUILDINGS rJE . CONNECTION CHARGE PkE
/'f �
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 .rO RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. 7I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /j 49
PITS AND/OR DRAINFIELD 2.00 STATION / / �"J DEPTH L1�
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 G,�/� �`/ MANUHOLE PPER REFERENCE
�
TYPE cPE 0A NECTION LENGTH FROM O
Y+� CURB ..B.1- M.L.TO P.L. ,2
OWNERS PERMIT ; I I 00. I ,,y
AUTHORIZATION I TOTAL FEEIHAVE THIS DATE CONTRACTED WITH THE HERE
NAED
CONTRACTOR TO CONNECT THE ABOVE D SCRIBEDI EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------9_L.....DAY OF_...iTl��` -----------_.....19 NEW HOUSE SEWER (Ilyt�,ogp,Qjl 7-2,61-il
OWNER OA CONNECT ADDITIONAL
BUILDING OR WORK
p SEPTIC TANK,SEEP.PIT(S)
ADDRESS../.LY AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E] DRYWELL E]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 LICENSE�aa-RE3UIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN,-
ER OF THE ABOVE ESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ! /(�4f7ulilAACI�JU 7 fJSU
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE - / . -
7GA642A 663 9/53