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HomeMy Public PortalAbout10903 GRAND AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 0 APPLI�FO APPLIC .TO FILL I �//� LOCALITY ADDREBUILDISNEAREST S CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PE RM LOCALITY I ,J N0. NEAREST ! A �2 `F'�o J C CROSS ST CCJI RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL USE ZONE OCCUPANCY MAP ADDRESS 7� 70 / - � BK PG CIT TEL. CONTRACTOR CO.IMP.N0. � ESSJlrA W,I AM JOB NO. E 9/ TRUNK PER NO. TE RE ISTRATIO NO. COUNTY ROAD PERMIT N L GAL / STATE ENCROACH NTS DESCRIPTION OT ` PERMIT NO. BLOCK TRAGI INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLDGS. NOWeQN LOT XHAWllES USE OF BUILDINGS CONNECTION CHARGE FEE ',J NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FE9- HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3.50 RECEIPT NO.; DATE,, I BY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDti.OR EXCEPTION RECOR D WORK TO HOUSE SEWER 1.00 NO. —ALTER OR REPAIR EXISTING I 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 9 � DEPTH , CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 AMFERENCE LOlIft TYPE OF CONNECTION LENGTH FROM d OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L. 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-------------_-_-DA ....... _.._--____------ _.__.19._. _. NEW HOUSE SEWER y7 OWNER OR CONNECT ADDITIONAL OWNERS AGENTBUILDING OR WORK ADDRESSEPTIC TANK,SEEP.PIT(S) -•--- ----- - -- - -• - --.-•-•-- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL Ej CATION AND 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 1 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 DE CRIBEDESIDENTIA PROPERTY. BACKFILLSEPTIC TANKS � ' SIGNATURE }/� SEEP.PIT(S)C] CESSPOOLS Z ZLV OF PERMITTEE ------ ----------- -•----- 76A642A 663 7/53 DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER I BUILDING ADDRESS t ©" cl)-'S FOR APPLICANT TO FIL ISI LOCALITY BUILDING NEAREST ADDRESS o a CROSS SL LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. CC NEAREST S A ROSS ST. 1 r. iRECEiVED BY Ready for Inspection DATE ISSUED OWNER h � MAIL ADDRESS "" USE ZONI�,, OCCUPANCY MAP BK PG CITY r TE .NO. CONTRACTOR _ CO.IMP.NO. ADDRESS { JOB.NO. CITY TEL.NO. - �' TRUNK PERMIT N0. 1 STATE REGISTRATION NO. Q COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. STATE ENCROACHMENT PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLOGS. NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $ 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 R R OEPAIR EXISTING NO I DATE 1 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—DRYWELL SPECIAL CONDITIONS ONLY 2.00 I Q MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM Y. CURB P.L. M.L.TO P.L. OWNERS PERMIT $ I I 00 AUTHORIZATION 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--------------------DAY OF............_..........................19.......- NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT----------------•--------------------------------------------------.----------- BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) ADDRESS...-- ......------ -----........................- --------..................... AND/OR 0RAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL�GRYWELL CATION AND 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 1 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 DESCRIBED RESIDENT)AL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE - J/ SEEP.PIT(S)� CESSPOOLS[-] OF PERMITTEE----^- ------ ' --------•----`-- f.............._._... 76A642D C63 1/53