HomeMy Public PortalAbout6021 HART AVE_Sewer__ 1,41%PPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DOSPOSHL
Department of County Engineer
. County of Los Angeles BUILDING / !Z- 2
' WM.J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUP•T OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN NEAREST
CROSS ST. -
LEGAL
DESCRIPTION LOT NO.. 3 OWNER /
BLOCK TRACT -/ 0 - ADDRESS W AQ S
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY J TEL. NO.
USE OF
BUILDINGS K
�J DISTRICT N0.. GROUP JG MAP PG
/G
-CONTRACTOR F{ / '
ADDRESS !V A, CONNECTION DATA
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CITY . a S(�6�Q� C( TEL. NO. �...�� [ 6 f- STATION DEPTH O
TTMANHOLE REFERENCE �J _UPPER
REGISTRATION N0. Y
No. DESCRIPTION OF WORK FEE ®
TYPENECTION. LENGTH FROM d
PUBLIC HOUSE SEWERCONNECTING TO @ $ 3.501 �G Y. CURB P.L. M.L. TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 �p
CONNECT ADDITIONAL BLDG. OR ®�71 67 P.B O.
WORK TO HOUSE SEWER 1.00 Q � CO. IMP. N0. U JOB N0.
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL.CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S PERMIT 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE CON-
TRACTORTTOS CONNECT DATE O THE ABOVE WDESCR BED EXISTING ITH THE HEREIN A DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THISDAY O
' F 19 NEW HOUSE SEWER s
OWNER OR y CONNECT ADDITIONAL
OWNERS AGENT- BUILDING OR WORK -
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES -AND STATE LAWS REGULATING ALTER;REPAIR,SEWER OR.
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 M THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIA ROPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS❑ % 6
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX.CO TY ENGINEER ' VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
115 6 5 0 ,%trk .