HomeMy Public PortalAbout6047 HART AVE_Sewer__ DEPARTMENT OF COUNTY ENGLYEER j SEWER—SEWAGE ®95P®Scud
DIVISION OF BUILDING ARID SAFETY PERMIT APPLICATION! .
COUNTY OF LOS .aANGET S
WILLIAM J. FOX, COUNTY ENGINEER ;I BUILDING
ADDRESS
FOR APPLICANT TOF LL IN LOCALITY f
[.ADDRESS
DING //4�+� ' �J' NEAREST
RESS CROSS ST.
ALITY DISTRICT NO. SERIAL NO. a� pPrE-RMITT NO.
RESTA� � d�0eRAs
SS ST. ECE�VED BY Ready for Inspection DATEISSUED
ERL USE ZONE OCCUPANCY MAP
RESS !�,.�$ BK PG
0 TEL.NO.TRACTORCO.IMP.NO. �""JOB.NO.
46 J lle__TEL.NO. TRUNK PERMIT N0.
STATE
REGISTRATION NO. (��� Q ® COUNTY ROAD PERMIT NO.
e
LEGAL c9 q
DESCRIPTION LOT N0. 1 PERMIT NOSTATROACHMENT
BLOCK TRACT `+ � ® INDUSTRIAL _
WASTE APPROVAL
SIZE OF LOT NO.OF LDGS. CHARGES
--NOW ON LOT
USE OF I
BUILDINGS CONNECTION C FEE
NO. DES R PTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER $ 3.50 RECEIPT NO. E BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG:OR CEPTION RECORDS
WORK TO HOUSE SEWER 1.00 1A NO
ALTER OR REPAIR EXISTING DATE 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 D � DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLC UPPER REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I 00
Y. CURB P.L. M.L.TO P.L.
- $ I
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----_------------DAY OF______.____—_ ._______19..._-. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...................................................................... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
-ADDRESS------------------------- AND/ORORAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL El `
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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)o CESSPOOLS E
OF PERMITTEE +�.___._ �-----
76AG42A 663 7/53