HomeMy Public PortalAbout5570 GLICKMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
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FOR APPLICA4TjO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY . DISTRICT NO. SERIAL NO. PERMIT NO. C
NEAREST
CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED
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CITY TELAO.
CONTRACTOR rn reap wn ��� SSI
ADDRESS JOB.NO. p Q�
CITY TEL.NO. �;.NO.
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REGISTRATION NO. COUNTY, ROAD PERMIT NO.
LEGAL i
s`
N LOT N - STATE ENCROACHMENT
DESCRIPTIO
' �, -- PERMIT NO. -
1361`K " A a pr WASTE APPROVAL
SIZE OF LOT /C NO.OF BLDGB. / CHARGES
C J NOW ON LOT
USE OF CONNECTION CHARGE FEE
BUILDINGS �_.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER $ 3.50 �c CI RECEIP T I BY
HOUSE SEWER CONNECTING TO .✓
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCE TION ECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. 'DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECT40N DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION '' DEPTH f%
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
-- .... '�VPPER-,�...- -.- -.�._... LOWER
TYPE OF CONNECTION LENGTH FROM/
Y. CURS " " P.L. M.L.TO P.L.
OWNERS PERMIT S 1 1 00
AUTHORIZATION I TOTAL FEE
I 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
SIGNED THIS......._._._-.DAY NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL
�!¢•�'�
OWNERS AGENT_.. BUILDING OR WORK
_--^- -...- -..----...-.._ .___.._-._..-.._----.--•--.
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--------------------------..._......................................................... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[3DRYWELL❑
CA
TIONAND 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL,PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE .. S„FEP.PIT(S) CESSPOOLS
OF PERMITTEE. �= ---------•------ -- ❑ E]
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