HomeMy Public PortalAbout5325 GLICKMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER (k? SEWER—SEWAGE DISPOSAL
n DIVISION OF BUILDING"AND SAFETY PERMIT APPLICATION 31
COUNTY OF LOS ANGELES _ T
WILLIAM J. FOX, COUNTY ENGINEERBUILDING I ADDRESS J F`Ae �
FOR APPLICANT T ) FILL IN LOCALITY
BUILDING �I ' NEAREST
ADDRESS pV , A �Js�1t�s" CROSS ST. p �
LOCALITY"7 '- �� r �� r DISTRICT N0. SERIAL N0. PERMIT NO.
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NEAREST ' CJ
CROSS ST. 1 :�a, ��,(,. �;`^ � r_/ ;! rf'; ✓�
RECrEEIIVED BY`-1 Ready for Inspeotion DATE oSSUED/,
OWNER � G/ c
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ADDRESS U ` T� Z � a USE ZOMAIL "� OCCUPANCY —MAPS
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CITY TEL.NO.
CONTRACTOR .California Sewer Const•Co• CO.IMP.NO. -57` pl"
ADDRESS 1317 Colegrove Ave.
JOB.NO. _
CITY Montebello TEL.NO.UNion 1-5048 TRUNK PERMIT NO.TE
-
REGISTRATION NO. 104445 SpDUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT N0.
BLOCK TRACT //� INDUSTRIAL
f WASTE PPROVALNO.OF BLOG
SIZE OF LOT (5X NOW ON LOTS fl CHARGES
USE OF
BUILDINGSr CONNECTION CHARG FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 In RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR E, EPTI�N RECORDED
WORK TO HOUSE SEWER 1.00 Ng
ALTER OR REPAIR EXISTING I VE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTIO DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DP.AINFIELD 2.00 STATION 3DEPTH .
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �r MANHOLE REFERENCE
UPPER LOWER .
.rte v
T "pyyg� TO P.L.PE OF CONNECTION , LEIiGTH FROM
r M.L. ,
OWNERS I PERMIT $ � 1 00
AUTHORIZATION TOTAL FEE °�,j6
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THF PU LIC SEVJER
SIGNED THIS------ . Y OF.__.__. __ � _.___19----
9 NEW HOUSE SEWER zll,,Js J ,.Y i m
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT._ BUILDING OR WORT(
- -
a SEPTIC TANK,SEEP.PIT(S)
ADDRESS- .... ...0.. - . .. AND/ORDRAINFIELD
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 ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESC {BED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE � / SEEP.PIT(S)[:] CESSPOOLS
OF PERMITTEE- ---- ----
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