HomeMy Public PortalAbout6161 HART AVE_Sewer__ 76A 642L CEBOS 13-7/76 {i PPLOCATOON F®R PERM OT ,
SEWER—SEWAGE DISPOSAL_
FOR AP L•ICFCN 1 IO FILL IN DISTRICT NO. GROUP MAP 2a_OCESSED BY
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CITU �CI�/ t e I/r TEL. NO. 213-2 uS 5701( CO.IMP. NO. JOB NO. //��
LEGALH2�4 C-M., -pr MoRtNN2�Y TRUNK PERMIT NO. ROAD PERMIT No
DESCRIPTION DESCRIPTION LOT NO.'H214 T 7�C
p tf-&T fk IV 13 'rr Z 15, �'y(V�' AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR.NO. DATE `
BLOCK 6100 TRACTS' d S0v t✓ U Ftr't
ZZ NOWOON LOTS
SIZE OF LOT J 3 IOb 3`' .HW V.OR ST.WIDENING
BUIILDINGS p I pr��c' G JaQ S STATE ENCROACHMEN•I---�^
PERMIT NO.
CONTRACTOR �R- � INDUSTRIAL
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WASTE APPROVAL
ADDRESS 78 W. k/4$ F/,ae!_S CHARGES O
CITYP-RCAPI4 TEL. NO. / 6�/ CONNECTION CHARGE FEE '
STATE LIC REIMBURSEMENT FEE
LICENSE NO. GLASS
NO. DESCRIPTION OF WORK FEE APPROVALS
DATE INSPECTOR'S SIGNATURE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @
SEPTIC TANK.SEEPAGE PIT OR NEW HOUSE SEWER A22
PITS AND/OR DRAINFIELD @ CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM @SEPTIC TANK.SEEP,PIT(S)
CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXT.N.,CESSPOOL.DR YW ELL.MANHOLE @ CESSPOOL [IDRYWELL El
ALTER.REPAIR OR ABANDON HOUSE ALTER,REPAIR.SEWER OR
SEWER OR DISPOSAL SYSTEM @ SEWAGE DISPOSAL SYSTEM
" DISCONNECT PLUG AND
ABANDON HOUSE.SEWER -
- - BACKFILL SEPTIC TANKS. ❑
-- SEEP.PIS) El CESSPOOLS [3OWNER"S TIssuance Fee $
.I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AUTHORIZATION TOTAL FEE " AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
I HAVE AT THIS-DATE A CONTRACT WITH THE HEREIN NAMED CON WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING PLUMBING AND SEWERS:
TO THE PU BLIC. SEWE . I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
M LICENSED 'AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF
SIGNED THIS DAY O fvl 19 � CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. ND INTEND TO
OWNER OR o RESIDE IN, THE ABOVE DESC ENTIAL OPERTY.
OWNERS AGENT {J C
ADDRESS �" �tA VlT A�l.� �J/�`�'I� SIGNATURE
1, ,I OF PERMTTT
VALIDATION _
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