HomeMy Public PortalAbout6362 GOLDEN WEST AVE_Sewer__ DEPARTMENT OF COUNTY ENG1NEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY 1
PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BILD
ADDREUSINSG
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS �7J L Z- � ������ ��`'� ��-�
CROSS ST. I
LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO.
cc
NEAREST A `J r J
CROSS ST. \ RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL !1-
ADDRESS USE ZONE OCCUPANCY MAP
_ BK PG
CITY C7 01- TEL-NO- DA
I"S /
CONTRACTOR &C CO.IMP.NO.
ADDRESS
JOB N0,
CITY TEL.NO.0 �, O TRUNK PERMIT NO.
a _s
REGISTRAT N N0. COUNTY ROAD PERMIT NO. `7
LEGAL /1 STATE ENCROACHMENT
DESCRIPTION LOT N0. l� PERMIT NO.
BLOCK TRACT ZIT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 75".x' / qV NOW ON LOTS C CHARGES
USE OF
BUILDINGS 4 �� y CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER u@ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO 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—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 �✓ r �- MANHOLE REFERENCE LOWER
TYPE OF CONNECTi LENGTH FROM
OWNERS PERMIT $ I 00 Y. CURB ;. P.L. M.L.TO P.L. /
AUTHORIZATION r 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.__. (,____ - Air OF___- �_ __._.145�/ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGEV.___ .� .... _ !�_.� _. BUILDINGORWORK
7 w(� "kLGJ SEPTIC TANK,SEEP.PIT(S)
ADDRESS------ 1- --6.1;c Y� - _- Z..._
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THA HAVE READ THIS APPLI. CESSPOOL E] DRYWELL E]
CATION AND STATE THAT THE ABE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY OR INANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THATRE AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA 0 THAT 1 mAM THE LEGAL OWN-
ER OF THE ABOV E IBE ENTIAL, ROPERTY. BACKFILL SI P C TANKS[]
SIGNATURE
j , � `SEE P. IT(S),4 CESSPOOLS(:j
OF PERMITTEE........
76A642A 663 7/53