HomeMy Public PortalAbout4820 GLICKMAN AVE_Sewer__ •7SA642D APPLICATION FOR PERMIT 1
S&E•663 12.54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
° Department of County Engineer //�j / e/n�J �/
County of Los Angeles BUILDIADDRENG
J7 O - b C /f�lf/'% �}�V
WM.J. FOX, COUNTY ENGINEER T r
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY �--, 7-y
FOR APPLICANT TO FILL IN ceoss ST ,�byt/k
LEGAL
DESCRIPTION LOT NO. J '( ,/�IJOT�Thr /+4 OWNER f�`! CL_,
BLOCK TRACT /a�L�Z MAIL
e ADDRESS
NO. OF BLDG
�1C q ® W ON LOTS
/
SIZE OF LOT NO /
,�a CITY TEL. NO.
USOF
BUI �"` vv p _✓/�' �,l�1A/a- DISTRICT NO. GROUP MAP
CONTRACTOR L-7 /y�RN, 61f ,4/t/ �L I I BK ill
till
ADDRESS Ale �U j"�/, , ,�jA COYdPTECTIOIV DATA
CITY ',GAN% TEL. NO.�"�Q �j�(� / STATION �' DEPTH /J
(� STATE MANHOLE REFERENCE
REGISTRATION NO. — � "' A� �y -,Y ❑ COUNTY .IJF�iidl' z!5/,.�;I.'VWLOWER
TYPE OF CONNECTION LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L. �C
HOUSE SEWER CONNECTING TO V Q
PUBLIC SEWER coil $ 3.50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. / ��-/ 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 DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL _ WASTE APPROVAL
SPECIAL CONDITIONS ONLY .2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE D CRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S WER 0—
SIGNED
SIGNED THIS DAY OF 1923 NEW HOUSE SEWER rI��
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS 'Sl*A SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 SEP❑C TANKS❑
SEEP.PIT(S) CESSPOOLS❑
SIGNATURE
OF PERMITTEE
Imsmicangmmam
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
BY '. _1AW ABY 4.jr ^ OY
DEPUTY 1 1c / DEPUTY "
BY BY
® DEPUTY DEPUTY