HomeMy Public PortalAbout6148 HART AVE_Sewer__ ` DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
UILWILLIAM J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT Or BUILDING
FOR APPLICANT TO FILL IN LOCALITY / P : . h� "v
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. �PERMTT NO.
NEAREST17
CROSS ST. C. - RECEIVED Y Ready for Inspection DATE ISSUED
OWNER
MAIL t�
ADDRESSUSEZONE OCCUPANCY MAP
• I BK PG
CITY TEL.NO.
CONTRACTORh�c1�P CHARGES REIMBURSEMENT FEE
ADDRESS REQUIRED
NOT REQUIRED
CITY TEL.NO.
JOB.NO. CONNECTION CHARGE FEE
STATE
REGISTRATION NO. COUNTY CO.IMP. NO.
LEGAL RECEIPT NO. DATE I BY
DESCRIPTION LOT NO.>lt I t�- '
BLOCK TRACT ,` WAIVER FOR RECORDING
NO.OF BLDGS.
SIZE OF LOT 1' NOW ON LOT RECEIPT NO. I DATE BY
USE OF "
BUILDINGS
NO.I DESCRIPTIONf OF WORK FEE TRUNK PERMIT NO.
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLICSEWER @ $ 3.50
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION DEPTM.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL I I UPPER LOWER
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTION LENGTH Ff(iOM
Y. CURB P.L. M.L.TO P.L
OWNERS ER $ I 00
AUTHORIZATION JPMIT
TOTAL FEE
1 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
ADDRESS.------_..... -
..............'--- .............. ........ SEPTIC TANK,SEEP.PIT(S)
------------� 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
RECULAT'NG PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I DISCONNECT PLUG AND
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
USE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE 1_., ;. r SEEP.PIT(S)[:J CESSPOOLS
OF PERMITTEE.= - ----------- ------------i--•--•-:...................
76A6421) 663 12/"