HomeMy Public PortalAbout6034 HART AVE_Sewer__ 76AE-66 A G P 11 I& _Aq�T kl l9 FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEDER 7SEWAGE DISPOSAL
Deportment of County Engineer MINIS
County of Los Angeles BUILDING -13fe Al Ila"' G ��,cnad
WM.J. FOX_COUNTY ENGINEER ADDRESS .sem
® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY
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FOR, APPLICANT TO FILL IN NEAREST
CROSS STS`(9' h
DESCRIPTION LOT N0. r�'%'3 - OWNER +"� V�,�4rVeW41,t 1 �a.j✓d/7
MAIL
BLOCK TRACT ,nj�Q y J ADDRESS �03�,6/��/�✓s�6'(r /i�✓� jaj�j�G C
SIZE OF LOT � -d' NOW ON.LOTNO OF S / CITY z, 21 !(, O,/ TEL. NO. 4r- ��� o
USE OF DG[J�/��
BUILDINGS ! DISTRICT I GROUP MAP
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CONTRA OR t 17 c-- � v
ADDRCS ° p CONNECTION DATA
CITY
EL. NO ppp, �..r STATION �7 DEPTH LE/'
�//m ,J ❑ STATE MANHOLE REFERENCE
REGISTRATION NO. �O ✓�J ❑ COUNTY /46 AlaV OWE
No. DESCRIPTION OF WORK FEE TYPEyNECTION LENGTH FROM D
HOUSE SEWER CONNECTING TO $ 3.50 I Y. /(CURB j NP.L. 51.L. TO P.L. _
PUBLIC SEWER
HOUSE SEWER CONNECTING TO
41 PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR /f07 !y// P. C. O
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. t/ JOB NO.. e
ALTER OR REPAIR EXISTING -- TRUNK PERMIT NO. ROAD PERMIT NO.1 e Q
SEWER OR DISPOSAL SYSTEM 1.00 JJJ G66"'
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE Ci U ISL
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE
r ///
NEW HOUSE SEWER X. .. J�,
SIGNED THIS DAY OF 19_ O �F
OWNER OR t D �, 1 -Z% CONNECT ADDITIONAL
OWNERS AGENT p: CiC 000"`CCl /!//� � P-�I BUILDING OR WORK
ADDRESS-
AND/OR"'(�R�`i.. /Y.pA,�.;�G'6Gr CFQ✓,sY"A SEPTIC TANK. SEEP, PIT(S).
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIAL 2aQPERTY.
BACKFILL SEPTIC TANKS❑
/f f SEEP. PIT(S) ❑ CESSPOOLS •I� ,/JYI'1/f✓1.�G(:1G0.�,
SIGNATURES%�,
OF PERMITTEE � -
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION ft.A.WOOD. CHIEF PLBG. INSPECTOR
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