HomeMy Public PortalAbout6127 GOLDEN WEST AVE_Sewer__ DEPAIVVAMNT OF COUNTY ENGINEER ( SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY �_ (,� pERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER II BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY 1 1 1
BUILDING NEAREST
1 P7
ADDRESS 61, 27- Golden dWasti CROSS ST. a, r+ v
LOCALITY ���10 Cf DISTRICT NO. w SERIAL NO. PERMIT NO.
NEAREST t
CROSS ST. Garii�alldi Ave. A � r7 I S
ECEIVED BY Ready for Inspection DATE ISSUED
OWNER L R Mears, 4cl-If�!Cq4
MAIL USE ZONE OCCUPANCY BK MAP PG
ADDRESS
CITY 7J
TEL.NO. —I � _
� L1
CONTRACTOR fledge ZnO1lwberg CO.IMP.NO. •2
ADDRESS A322 N, GOldenweat Ave, JOB NO.
CITY 1 TELAO. At *67212 TRUNK PERMIT NO.
_STATE
REGISTRATION N0. 14105574
I _16'COUNTY ROAD PERMIT NO.LEGAL
DESCRIPTION LOT NO. g? 11�4•1c; --<7.0"a F ZJ� STATE ENCROACHMENT
NOROACHMENT
BLOCK N TRACT Unita Anita Land C INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO.OF$EGGS.
GOA 2 OF NOW ON.LOT $' CHARGES
-BUILDINGS DINGS Thmil'I Tliz — Garage �CONNECTION-CHARGE FEE
NO. DESCRIPTION 09—WORK F E
HOUSE SEWER CONNECTING TO ��yy�� REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 ~JV RECEIPT NO. E I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
\� CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 OO
ALTER OR REPAIR EXISTING NO_ I DATE BY \
SEWER OR DISPOSAL SYSTEM I.00 1
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION �) DEPTH �I
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 ! MANHOLE REFERENCE
LOWER
TYPE0 ON ECTION LENGTH FROM
OWNERS PERMIT $ 1 00 ' r CURB' ciAh. M.L.TO P.L.
t!
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_e ______ __DAY OF_ 19__ NEW HOUSE SEWER r�i —a ¢.
OWNER OR ' ,CONNECT.ADDITIONAL
OWNERS AGENT.. 1�Q�L�!4 /��_,1 !.� (BUILDING OR WORK
......._...____. SEPTIC TANK,SEEP.PIT(S)
ADDRESS.......
..................... ......••.... AND/OR DRAINFIELD
v
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
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 IAM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE-LEGAL OWN- ABANDON HOUSE SEWER -
ER OF THE ABOVE DES (BED RESIDEhITI5.j?PROPERTY BACKFILL SEPTIC TANKS S
SIGNATURE /7�1/J SEEP.PIT(8)� CESSPOOLS
OF PERMITTE _
70A042D 663 1/53