HomeMy Public PortalAbout6238 GOLDEN WEST AVE_Sewer__ DEPARTbYENT OF COUNTY ENGIIVEEIt SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING-AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT 10 FJLL IN LOCALITY
BUILDING NEAREST V
ADDRESS CROSS ST.
LOCALITY DISTRICT NO A A SERIAL NO. �PERMIT NO. �-
J
NEAREST •L"
CROSS ST. - RECEIVED
Ready for Inspection DATE ISSUED
OWNER
MAIL j
ADDRESS USEZONE I OCCUPANCY I B�P_
CITY �r TEL.NO. a / / A4 G 7 PO
CITY
CONTRACTOR
CO.IMP.NO. Ga p•L � !_ �
ADDRESS JOB.NO.
CITY TEL.NO. T 2/1-1 TRUNK PERMIT N0.
RATION.NO.. - DSTATE
REGIST � COUNTY"
ROAD'PERMIT N0
LEGAL
DESCRIPTION LOT N0. / STATE ENCROACHMENT
m '�' S. �n PERMIT NO. ------�
BLOCK TRACT //3 PGO WASTE APPROVAL
N0.OF BLDGS. �+
SIZE OF LOT >x/,S NOW ON LOT I t CHARGES ^ �•
USE OF l l� �'U
BUILDINGS (]� ��,f� CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE +
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ 3 3.50 _ �(J. RECEIPT NO. I ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR E EPTION R CORDED
WORK TO HOUSE SEWER 1.00 N I DAT 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
PITS AND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE
a LOWER
TYPE OF CONNECTION LENGTH FROM r� �^Q
OWNERS PERMIT $ I 1 00 -Y� CURB �v M.L.TO P.L. OC V
AUTHORIZATION TOTAL FEE 6v
1 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_ 1 _Iq� NEW HOUSE SEWER �c (l a�� n�Ia R- ry
OWNER OR -- '- b _- -^ - Y- - �' CONNECT ADDITIONAL
B
OWNERS .A ENT.-.-.......�j...._- UILDING OR WORK
ADDRESS - - r�! AND/OR DRAIPIT(S)
NFIELD
t
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE 18 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 BY LOS ANGELES COUNTY,. ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL,OWN- _
ER OF THE ABOVE D CRIBED RESjirlENTIAb PROPVTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)� CESSPOOLSIA ( /III UUA/fYG�C�� q'ZZ41:
OF PERMITTE �._
7GA642A 663 7/53