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HomeMy Public PortalAbout6125 HART AVE_Sewer__ DEPAK.9MIgNT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING 61 G � NEAREST 11,4R CRS S . (7= a�U1L LOCALITY „ DISTRICT NO. SERIAL NO. PERMII/T/NO. c NEAREST /JA q % ��� / A 1 8 l �fj J CROSS ST. (� �{� / �• R CEIVED BY' Ready for Inspection DATE ISSUED OWNER /Y e C �aec�er MAIL I� ADDRESS (® � Z 3/ /�e USE ZONE OCCUPANCY BK MAP PG CITY TEL.NO. — I I F_— CONTRACTOR _ CONTRACTOR r % CO.IMP.NO. tet' © '\ C ADDRESS /f ��♦,Q�j%r� S JOB NO. CITY 4 Z TEL.NO. ,�"r,� •3 7 3 TRUNK PERMIT NO.STATE REGISTRATION NO. � COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT N0. /, �� STATE ENCROACHMENT o ' `}� PERMIT NO. BLOCK TRACT —9, V [¢. INDUSTRIAL --�-1 /� �/y WASTE APPROVAL SIZE OF LOT TQ I ��� NOW ON LOTS / d�'✓ CHARGES �f BUE DINGS /;/ �- /Vo!wx&— CONNEC IT OFACHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE r _ - PUBLIC SEWER @ $ 3.50 j'P, RECEIPT NO. I -,,DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL I BLDG..OR / v d ,/EXCEPTION RECORDED``WORK TO HOUSE SEWER 1.00 I ALTER OR REPAIR EXISTING /� N0. I 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 �� DEPTH CESSPOOL—DRY W ELL SPECIAL CONDITIONS ONLY 2.00 I �1 S 1 C, A(� ol{1ANUP UPPER REFERENCE L0 cG TYPE`07 CI\OI_ ECTTION LENGTH FROM OWNERS PERMIT $ IA cUl;en - M.L.TO 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 11 SIGNED THIS.._._i__ ......DAY If------- --e........._....194`, NEW HOUSE SEWER OWNER OR /�' CONNECT ADDITIONAL OWNERS AGENT...... ___----..._.._ BUILDING OR WORK ADDRESS......_--------_---1..-.........I----------. SEPTIC TANK,SEEP.PIT(S) -_ •---•--•-------••--------------•-•--•-----•- AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• _ CESSPOOL Ej DRYWELL E 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 I 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 RESIDENTIAL�pPROPER Y. BACKFILL.SEPTICTANKS � SIGNATURE {�/./ / y SEEP.P.IT(S)o CESSPOOLS E OF PERMITTEEI'-5.--_--. eG4/ -._..._..- - 76A642A 663 7/53