HomeMy Public PortalAbout5929 HART AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER' SEWER—SEWAGE DISPOSAL
DIVISION'. OF BUILDING AND SAFETY ; PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX,, COUNTY ENGINEER I ADD EISS � G/' � r .,���'
- LOCALITY r i
FOR APPLICANT TO FILL IN C
NEAREST
ADDRESS `.]9 29 �I mArt Ave CROSS ST.
LOCALITYDISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST
`�' )0-6 I Lift _!�7_ A 3 leo 6/ S
CROSS ST. j =10,.� RECEIVED BY Ready for Inspection I A�i•E ISSUED
OWNER c)m �� // IS' 451
MAIL �- USE ZONE OCCUPANCY, BK MAP PG
ADDRESS
CITY Wimmb TELAO. At ! 57
CONTRACTOR (3nmege 1d14JlFyA1aLonbex� (' CO.IMP.NO. 41-",3
ADDRESS 6522- x. aivaldm Its al JOB NO. t
CITY zismag TEL.NO_ M .6721a TRUNK PERMIT NO.
REGISTRATION NO. 1�i'f�!/ItT(4 COUNTY'. ROAD PERMIT NO.
LEGAL > j6' f,37 413
DESCRIPTION LOT NO. *40 lit alf Lot i PTATE
ERMIT NOROACHMENT.
AtKm`
BLOCKTRACT � f1A + INDUSTRIAL
* NOW ON g s WASTE APPROVAL CHARGES,
SIZE OF LOT40. jaa NO.OF BLDGS.
LOTFJ
USE OF � � ® ltBlT g CONNECTION CHARGE FE
NO.I DESCRIPTION OF WORK FE
lff REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER Q $ 3.50 Le RECEIPT NO. I DATE IBY
' HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
r
CONNECT ADDITIONAL BLDG.OR I EXCEPTION R CORDED
WORK TO'HOUSE SEWER 1.00 I '
ALTER OR REPAIR EXISTING NO. DATf
_ BY.SEWER OR DISPOSAL SYSTEM 1.00 I f
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.60 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR STATION DEPTH
_PITS AND/OR ORAI NFIELD 2.00 STATION
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2:00= " UPPERJMANHOCE-REFERENCE , OiNER
' TJ'
TYPE 0 Clg" CTION LENGTH FROM
OWNERS PERMIT_. $ I 00. � CURB w'L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEED
1 HAVE.THIS DATE CONTRACTED.WITH`THE HEREIN NAMED:
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING;
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS.. .._....DAY OF....,.*� _......_ .__._ 19 .. NEW HOUSE SEWER ( YD COWNER BR- (tom,[J� CONNECT ADDITIONAL
OW#GEiS- RANT`j �- -- `�"Y:✓-"�e`�I�..e� BUILDING OR WORK
_....
} SEPTIC TANK,SEEP.PIT(S)
ADDRESS...-,;k----- ._ .�.._�.:,a__.1 .... ._�-! AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE"READ THIS APPLI•- CESSPOOL[:] DRYWELL
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 A@IGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AMoTHE LEGAL OWN'-
ER OF THE ABOVE D RIBED RESt EN irAL PROPERTY. BACKFILL SEPTIC TANKS�
SIGNATURE / SEEP.PIT(S)C] CESSPOOLS❑
��► /► �q rt.
OF PERMITTEr _ .. .__�_�_
76A642A 663 7/53 .,