HomeMy Public PortalAbout6427 GOLDEN WEST AVE_Sewer__ DEPARTWNT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER I BUILDING J
ADDRESS
FOR APPLICANT TO FILL.IN LocAurY � C
BUILDING ' NEAREST
ADDRESS I CROSS ST.
LOCALITY DISTRICT NO. Ready for inspection �j PERMIT
NO. C
NEAREST S I J OCOMaCJ J
CROSS ST.
r CEIVED Y_42DATE IS UED BY DATE
OWNER
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MAIL
LADDRESS USE ZONE OCCUPANCY
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CITY TELMO. /fie r ,�BK �g
CONTRALTO
CO.IMP.N0.
ADDRESS 10B.NO.
CITY e.-o TELAO. TRUNK PERMIT NO.
STATE Q� _
REGISTRATION NO. COUNTY ROAD PERMIT NO. O �V
LEGAL STATE ENCROACHMEN
DESCRIPTION LOT N0. PERMIT NO.
BLOCK _Z: TRACT p, ,<'<'�� � � INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. e�
NOW ON LOT mer' CHARGES
USE OF T
BUILDINGS CONNECTION CHA E FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO r
PUBLIC SEWER @ : 8.50 RECEIPT NO. I "DOE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
LCONNECT ADDITIONAL BLDG.OR EXC N RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTINGNO• ATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONN ECTIO ATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION / DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
I 4+141EW— LOWER
TYPE OPOGWIKCTION LENGTH FROM SO
OWNERS PERMIT $ I DO �''� M.L.TO P.L.
AUTHORIZATION I TOTAL FEE S 56
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
F !
SIGNED THIS_..._ .DAY OF_.—_ __ t9_ NEW HOUSE SEWER
OWNER OR • CONNECT ADDITIONAL
OWNERS AGENT. BUILDING OR WORK
AGENT.-/--- .. - SEPTIC TANK,SEEP.PIT(8)
ADORES ............... - - _..._---------------------------------------------------- ANO/OR D RA I N F I E L D
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL[] 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF FORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE A E SCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
r
SIGNATURE SEEP.PIT(S)Ej CESSPOOLS
//��,,
OF PERMITTEE.._ .. 1�._�:
76A642D S&E 663 4/54 / /