HomeMy Public PortalAbout5600 GLICKMAN AVE_Sewer__ DEPARTDIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTYLOS ANGELES I ADDRESS �P
WILLIAM J. FOX, COUNTY ENGINEER
UILDING
FOR APPLICA T ILL IN LOCALITY
BUILDING .+ NEAREST
ADDRES CROSSST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT N0, C
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL V ADDRESS USE ZONE I OCCUPANCY ( BK MAP PG
�
CIT EL.NO.
CONTRACTOR 6
ADDRES JOB.N0.
C ` TEL.N �.S�L// TRUNK PERMIT NO.
STATE
REGISTRATION NO. 3f U COUNTY _
ROAD PERMIT NO.
LEGAL ��� STATE ENCROACHMENT
DESCRIPTION LOT N
PERMIT N0.
Ar 04-
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
NOW ON LOT
SIZE OF LOT NO.OF OLDGS. CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESiCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER $ 3.50 = RECEIPT NO.. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO. DATE I BY
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 I /
PITS AND/OR D_RAINFIELD 2.00 STATION DEPTH 0
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCEn
�` LOWER
TYPE OF CONNECTION LENGTH FROM
Y. 44" P-+-- M.L.TO P.L.
OWNERS PERMIT � I 00
AUTHORIZATION TOTAL FEE
IHAVE CONTRACTORS DATE TO CONNECT THE ABOVE DESCRIBEDED WITH THE EXISTING AED PPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO .THE PUBLIC SEWER
SIGNED THIS----_-----_-------DAY OF----------.19_. NEW HOUSE SEWER
OWNER OR /' � _ - CONNECT ADDITIONAL
OWNERS AGENT....... BUILDING OR WORK
4�-._--.._.-..- ..__._._........_ _._.._..- -
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--------------------------_____.........._.........._.........._.._...__-_.........._... AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E) 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFO IA ORT I AM THE LE"L OWN-
ER OF THE ABOVE D RIBED SIDEN L PRO TY. BACKFILL SEPTIC TANKS El
SIGNATURE - SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE - - . - -� - - . ------
76A642A 663 7/53
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL l o�
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELESy�
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING l;y
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING — n r NEAREST
ADDRESS -)(,00 G(1 CK yt�al^ CROSS ST.
LOCALITY 7_7 C DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A
CROSS ST. REC VEA-BY Ready for Inspection D ISSUED
OWNER a IA SQ z ell,
MAIL USE ZOO' OCCUPANCYBK MAP PG
ADDRESS IL
CITY I �,1 D e C { .. TELNO.
CONTRACTOR
ADDRESS ` v C JOB.N0. �e�_
CITY an�j ' �C���� TEL-NO.-DD 2�7W TRUNK PERMIT N0.
666��1 STATE
REGISTRATION NO. 8 COUNTY ROAD PERMIT NO.
LEGAL /
DESCRIPTION LOT NO. STATE ENCROACHMENT ------
PERMIT NO.
BLOCK TRACT—��(/ {i' �✓� INDUSTRIAL—
WASTE APPROVAL
SIZE OF lOT,60/\ /ZO NOW ON LOTS CHARGES
USE OF CONNECTION CHARGE FEE,,,,- ,."
BUILDINGS t,
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q = 3.50 RECEIPT NO. I DATE, � � (BY
HOUSE SEWER CONNECTING TO a /.I
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCE TION RECORDED
WORK TO HOUSE SEWER 1.00
NO. _DATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 r ��
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA J
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATIOw» -
CESSPOOL—DRYWELL b
SPECIAL CONDITIONS ONLY 2.00 LuPPIMFF R N •E "'""COWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURS
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 _ �J
SIGNED THIS--- -J _DAY OF_-_. _1q�/ NEW HOUSE SEWER
OWNER OR ^ CONNECT ADDITIONAL
OWNERS AGENT. `` ' ,1 BUILDING OR WORK
-......»..l.._ - .C_ _».._ »..�.�.r.._
S /1�1 SEPTIC TANK,SEEP.PIT(S)
ADDRESS--- -.__.._4r .--`-- --.. AND/OR DRAINFIELD
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E:] 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 ,
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL.PROPERTY. BACKFILL SEPTIC TANKS E)
'-`
SIGNATURE SEEP.PIT(S)[:] E]CESSPOOLS I � `r'�( W� t
OF PERMITTEE- -- •------•-•------------.-...--------•-•-•-•-w�------- �
76A642A 663 7/53