HomeMy Public PortalAbout5563 GRACEWOOD AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
e -WILLIAM J. FOX, COUNTY ENGINEER i ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
ADDRESS 5563 Gracewood Avenue NEAREST
cRoss ST.
LOCALITYArcadia DISTRICT N0, SERIAL NO. PERMIT N0,
NEAREST Live Oak A S
CROSS ST. --
RECEIVED BY Ready Tor Inspection DATE ISSUED
OWNER Kenneth V. Venolia
MA!L 5563 Gracewood venue USE ZONE OCCUPANCY BK MAP PG
ADDRESS
CITY TEL.NO. FO 0-5705 -� •,._
CONTRACTOR Owner CO.IMP.NO.
ADDRESS JOB.NO.
CITY TELAO. TRUNK PERMIT N0. -- - ----- -
STATE
REGISTRATION NO. ® COUNTY ROAD PERMIT NO. - -
LEGAL .'gee reverse side STATE ENCROACHMENT ^
DESCRIPTION LOT NO. FERMIT NO.
BLOCK TRACT INDUSTRIAL -
WASTE APPROVAL
SIZE OF LOT56 1 X 901 NOW ON LOTS One CHARGES
USE OF Residence
BUILDINGS CONNECTION CHARGE.,FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. 1 DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR XCEPTIbN RECORDED
WORK TO HOUSE SEWER 1.00 x0
ALTER OR REPAIR EXISTING // DATE BY
SEW_ER_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 D_RAINFIELD 2.00 STATION f� P DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �. �� MA!Ik P E�FERENC y '
w ' s LQR
TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT ; I I 00 w� M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
CONTRACTOHAVE IR TDATE O CONNECT THTED WITH THE E ABOVE DESCRIBED IEXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH UBLIC SEWER /
SIGNED THIS...-_-.--_-.DAY OF_.NOV@mb@r _19 53 NEW HOUSE SEWER ScGI YAC -
OWNER ORT'z
///j CONNECT ADDITIONAL
OWNERS A E�IS�tJ� -.1!J "t'_•5 _ _—_ _ BUILDING OR WORK
!!�� Gracewood Ave . SEPTIC TANK,SEEP.PIT(S)
ADDRESS--------------_- ---.--------_.-__._.-_.•...--.._.-.--.--•--•-----. AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVLSTATE
THIS APPLI- CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CAND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCANDTATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROREGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AEGAL OWN-
ER OF THE ABOVE DESCRIBED RE DE,NT1PERTY. BACKFILL SEPTIC TANKS ElSIGNATURE SEEP.PIT(S)� CESSPOOLSOF PERMITTEE. - - -- _ -•
76A642A 663 7/53
-114
c[% a420e ,D
75 APPLICATION. FOR PERMIT
COUNTY OF LOs ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION E
JOHN A. LAMBIE. COUNTY ENGINEERCOLEMAN W. JENKINS. AUP'T. OF BUILDING
FOS APPLICANT TO FILL ;7
DESCRIPTION LOT NO, owMz*
YAIL
/LOCK TRACT ADORES/ G
NO. OF ■LDO S.
SIZE OF LOT NOW ON LOT CITY TEL NO.
U/t OF DISTRICT NR /I
0. GOUP MAP PROCESStY
■ D■
UILDIN
/ c ED ro
CONTRACTOR N _
ADDRIN COMM=ON 10
CITY D TEL NO. 7 STATION DEPTH
`IICENSE NO. CI Aa f MANN REF[)tIMCI UPP"
L
LOW"
No. DESCRIPTrON OF WORK PES TYPE of [CTION LEHa FROM
HOUSE SEWER CONNECTING TO Y.EEWCU L.P.
PV LIC SER 0 $5.00
rTIC A G[PfT ' O.
PITS AND/OR DRAINFIELD 0 510.00
CO.IMF.NO. OS NO.
OUSE sirwiLR CONNECTING TO TRUNK PERMIT NO. P"MIT NO.
PRIVATE DISPOSAL SYBTEM 0 S2.00
CONNECT ADDITIONAL 9L.D0.OR AFFIDAVIT RECORD.1 NO. DATE
WORK TO HOUSE SEW" 0 83.00
OVERFLOW■K"AGE PIT.DRAINFIELD p
EKTN_CESSPOOL.DRYW[LLMANHOLE 0 915.00 HWY.OR ST.WI IND
ARADO OUSE
/ilV[R 7.00 STATE ENCROACHMENT C.%J
PERMIT NO. Z
INDUSTRIAL
��+ WAST[APPROVAL
O�EVNE:p•a S 2 00 CHARGES
CONNECTION CHARGE FEE
AUTHORI'LATION rOru FEE
I HAVE AT THIS DATE A 'CONTRACT RALT Wf41 THE H[R[IN NAY[D CON-
REIMBURSEMENT FEE
TRACTOR T0.CON N[CT THE ADDY][ D[SCRIS[D EXISTING DW[LLINO APr i10VAL�7
TO THE PUBLIC SEW". • DAT[ INSPECTOR'S SIGNATURE
SIGNED THIS DAY OR
OWNER OR NEVI HOURE
/ WER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
f[FTIC TANK.SEEP,PIT(/)
I HERESY ACKNOWLEDGE THAT.I HAVE RtAD THIS APPLICATION A-ND/OR DRAINFI[LD
AND STAT[ THAT THE ASgV[ IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REOU LATINO
PLUMSINO AND SEWERS. CESSPOOL ❑ DRYW[LL ❑
I HEREBY CERTIFY THAT I AY PROP"LY REGISTEIItIi AND/OR ALTER.REPAIR.SEWXR OR
LICENSED AS RtiOUIRZD BY LOS ANGLES COU D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AY TH[ LEGAL N" AN INTEND TO DI�CON N[CT PLUG AND
R[f IDE IN, THE ABO RI R [IITI L RTY ASANDON HOUSE SEWER
f IGNATU R[ SAC K%F ,L S[PTEC TANKS ❑
OF P"MTTT[[ ■[[T.PIT fS) LI CESSPOOLS
VALIDATION JACK R. ALLAN
ac. M.o CASH 7UP[RVISINO MECHANICAL WOINEER
65929 SU 210 9 5.00"