HomeMy Public PortalAbout6165 HART AVE_Sewer__ :76A642D,/ - - 8�"N2f7 9 LICB"'0TION u {1 U PERMIT., . ® &"16! S� .
6&E•663 12-54
DIVISION OF WELDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Eagiaeer
County of Los Angeles " BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDINP LOCALITY
FOR APPLICANT TO FILL IN,
NEAREST. s �/ <_r? / ,
LEGAL rr��
DESCRIPTIONOD �-.0%N,O� � c. •9 OWNER
BLOCK TRACT e , MAIL
ADDRESS '�U�:
.p< �n ) NO. OF BLDGS. •fy• -
SIZE OF LOT-1 ��4�.,ay !,, -fl NOW ON LOT CITY y:Fy-_,y,' �" ,TEL.NO.
USE OF
BUILDINGS _ _ DISTRICT NO. F GROUP MAP
• BK PG ,
CONTRACTOR®:F t .+�" '..y:�.. yr.�a ;�7�1.p + -.. •� I. -
ADDRESS i¢�/,/_? `# ✓.- >"v`�_N y,^^'"-� CONNECTION DATA
CITYt O
�' f�.'°i'i� TELN /,,S "lt�.�.; .- , STATION DEPTH
A STATE MANHOLE REFERENCE
REGISTRATION'NO. ed sf�. iG" ❑ COUNTY UPPER LOWER
5 TYPE OF CONNECTION 1 LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L.
r HOUSE SEWER CONNECTING TO
PUBLIC•SEWER' Qa $ 3:50.
HOUSE.SEWER CONNECTING TO .bu ,
_ PRIVATE DISPOSAL SYSTEM 1.00 .
CONNECT ADDITIONAL BLDG. OR CO, IMP.NO. JOB. N0."
WORK.TO HOUSE SEWER 1.00 ��
ALTER OR REPAIR EXISTING
SEWER.OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSA LSYSTEM 1.00 PERMIT NO.
SEPTIC TANK,'SEEPAGE PIT OR ( INDUSTRIAL
PITS AND/OR DRAINFIELD _ 2.00
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION TOTAL FEE 06, REIMBURSEMENT FEE 0 '
TRACTORHAVE T TOS CONNECT THE CONTRA
,ABOVECTED WDESCR BEDITH THE'H EXISTING NAMED
DWELLING APPROVAL'S DATE INSPECTOR'S SIGNATURE`
TO•THE PUBLIC SEWER -
SIGNED THIS-DAY OF /-23-If M1a�47N
� - - - -• -'NEW HOUSE SEWER
19
- OWNER �OR •• - CONNECT ADDITIONAL -
OWNERS AGENT .BUILDING OR WORK
SEPTIC TANK, SEEP,.PIT(S) -
ADDRESS -AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[IDRYWE_LL El
D-STATE THAT THE ABOVE IS CORRECT-AND AGREE TO COMPLY - -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING r ALTER, REPAIR,-SEWER.OR
PLUMBING AND SEWERS. SEWAGE DISPOSALSYSTEM -
I HERE-BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT- I AM THE LEGAL OWNER -OF THE ABOVE -
DESCRIBED RESIDENTIAL PROPERTY. - pppp BACKFILL SEPTIC TANKS❑
SEEP.PIT(S).[]-CESSPOOLS❑ _ _
SIGNATURE
OF PERMITTEE -
WILLIAM J: FOX, COUNTY ENGINEER VALIDATION NOVq
2.00
DEPUTY- DEPUTY
BY BY �1J,
°� DEPUTY' ii? 1 O ' U