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HomeMy Public PortalAbout5618 GLICKMAN AVE_Sewer__ DEPARTIAENT OF COUN= ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING ' NEAREST / ADDRESS CROSS ST. L LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A _S CROSS ST. - - REC•IVSD BY, Ready for Inspection DA)X ISSUED OWNER .• MAIL USE ZOOCCUPANCY ADDRESS / j, I BK PO CITY TEL•N0. CONTRACTOR ADDRESS JOB.N0. /•J CITY TRUNK PERMIT NO. STATE REGISTRATION NO. COUNTY ROAD PERMIT NO. DESCRIPTION LEGAL ;(/164 �. STATE ENCROACHMENT TRAN . 7 dw PERMIT NO. BLOCK TRACT�.� /'i�?! r'g1,,11/V ,,a INDUSTRIAL u WASTE APPROVAL SIZE OF LOT,,:' �: NO.OF SLOG N zly NOW ON LOT;E� / CHARGES USE OF CONNECTION CHARGE FEE �j =� BUILDINGS- _ >� NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE rHOUSE SEWER CONNECTING TO r 11 3.50 RFX.EI HOUSE SEWER CONNECTING TO P I BY I PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCkF6ION RfCORDED WORK TO HOUSE SEWER 1.00 NO. ALTER OR REPAIR EXISTING I 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 PITS AND/OR GRAINFIELD 2.00 STATION CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFEREIbCb- -. UPPSR wn TYPE OF CONNECTION NG�tI Fib. PERMIT $ I I 00 Y. CURB RC'- L.TO P.L. OWNERS AUTHORIZATION 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 OF...._... 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT....................�-._. - BUILDING OR WORK - - - - - ^- - SEPTIC TANK,SEEP.PIT(S) ADDRESS.. - - - - .... -=---.__........--••-••••••-.........--- AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL I] 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 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND DISCONNECT PLUG AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE j/�� - SEEP.PIT(S)E] CESSPOOLS 'm- l/f'{/ OF PERMITTEE-----------------------...:------ 76A642A 663 7/53 DEPAMUMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING / ADDRESS FOR APPLIC NT TO LL IN LOCALITY BUILDING NEAREST �— ADDRESS A CROSS ST. ��--F ( ` LOCALITY DISTRICT NO. p SERIAL NO. PERMIT NO. A S NEAREST ` CROSS ST. ° RECEIVED BY Ready for Inspection DATE ISSUED OWNE ^1 MAIL r USE ZONE OCCUPANCY MAP ADDR S � _ � A gl< PG T L.N CONTRA OR CO.IMP.NO. ADDRESS/— JOB NO. CPi TEL.N ' TRUNK PERMIT NO. TATE 7 REGISTRATION,NO. COUNTY ROAD PERMIT N0. � LEGAL / STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. BLOCK TRACT E INDUSTRIAL WASTE APPROVAL SIZE OF LOT ! /N0.OF BLDGS. G NOW ON LOT 4o— CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE NO. DEEWWPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 $ 3.50 RECEIPT NO. I I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RE kMOED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO I 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 _ PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE /. UPPER TYPEOF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y. A-- xj"s 's!t• M.L.TO P.L. AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH &4LHEREIN NAMED CONTRACTOR TO CONNECT THE ABOV SCRI D EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS___r�rtY_-_DAY —I � NEW HOUSE SEWER j - —- OWNER OR - 'j {/ CONNECT ADDITIONAL OWNERS AGENA.--.••fCl�'ZZ - _ j BUILDING OR WORK �rJ x SEPTIC TANK,SEEP.PIT(S) --- 1�.4�f11.i-- ADDRESS__--_c.�'~e�_1_•.______5,�1°'-'- '-- -• -• - -- --- AND/OR DRAINFIELD I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] ORYWELL❑ 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 Y LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIF0 IA OR AT I AM THE GAL OWN- ER OF THE ABOVE D RIBE ESIDENTIAL P ERTY. BACKFILL SEPTIC TANKS© SEEP.PIT(S)[:] CESSPOOLS SIGNATURE OF PERM ITTE - --- ...-. _---- --e�J!!t�► ----------- 76A642A 663 7/53