HomeMy Public PortalAbout5838 GOLDEN WEST AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAMFDX, COUNTY ENGINEER BUILDING
CASSATT D.. PADDRESS GRIFFIN, SUPT OF BUILDING
APPLICANT TO FILL INYn(r LOCALITY
BUILDINNEAREST
G z XJ aj'r%) GO), •y�J GROSS ST.
ADDRESS V
LOCALITY 5 DISTRICT NO. SEcRIIAL NO. PERMIT NO. C
NEAREST AS / S S
CROSS ST
y RECEIVED��/��'Y}} Ready for Inspection DATEISSUED
OWNER ,V � I !� �1 e^IEL4Y(iR -7-3-3
MAIL
ADDRESS USE ZONE OCCUPA#� QY MMA GA'
CITY TEL.NO.
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS 3 REQUIRED
NOT REQUIRE
CITY TEL NO. 73/�� JOB.NO. CO NECTION CHARGE FEE
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REGISTRATION N0. T'e BiINTY CO.IMP.N0. 13
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LEGAL RECEIPT N0. DATE BY_.
DESCRIPTION LOT N0.
BLOCK TRACT 1p �r l WAIVER FOR-R CORDING
C,S12E OF LOT) G / 7 NOW ON LOTS RECEIPT NO. I,� A DATE `� I BY
USE OF
BUILDING TRUNK PERMIT NO.
NO. DESCRIF ON OF WORK FEEHOUSE SEWER
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PUBLIC SEWER CONNECTING TO $ 3.50 .jv ROAD PERMIT NO.�
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO. ^�
CONNECT-ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION -�, 1 _ D PTH
SEPTIC TANK,SEEPAGE PIT OR / - �
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENC!5"(moo /�( Q
CESSPOOL—DRYWELL UPPER ' Q __-'LOWER,
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTION LENGTH FROM
CURB 'Pll: M.L.TO P.L.
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OWNERS PERMIT 1 00
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED FFXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH PUBLIC SEWER r
SIGNED THIS--.-- -.--_--DAY OF -----...... 191 NEW HOUSE SEWER
OWNER O
CONNECT ADDITIONALr I
OWNERS ARENT.---- --11_7 -- BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE+
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED S REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF 0RNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THEA VE ESCRIBED REST NTIAL PROP TY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)EI CESSPOOLS r[nC- �( etc ^ f 2N3
OF PERMITTEE - -- - - -
76A642D 663 12/52 '