HomeMy Public PortalAbout6167 HART AVE_Sewer__ DEPAIVrf4ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING ARID SAFETY PERMIT APPLICATION!
COUNTY OF LOS ANGELES
WILLIAM J. FCX, COUNTY ENDINEER I BUILDING �/� �`` //�
ADDRESS / r
FOR APPLICANT TO FILL LOCALITY -7,-L6 /i,
BUILDING / NEAREST /� v
ADDRESS (�+/� 7�0 d CROSS ST. 1`�Q 9, �1C�
LOCALITY �j DISTRILCT N0. SERIAL NO. v//�PE�RMI7T�U
NEAREST CJ A O.
/ ` 3 / //
CROSS ST. _ ,+.,g� ¢ C
RE1C,,E/IVE Y Ready for Inspection /DATEISSUED
OWNER i"V avs /0� 4-.5'-3
MAIL
ADDRESS USEZONE OCCUPANCY MAP
_ BK PG
CITY TEL.NO.AT 3-f-7 S
�" '/
CONTRACTOR " _ ,__ '-,�/ �p CO.IMP.NO. 2, g 9 C_
ADDRESS
JOB NO.
CITYVT
TEL.NO..5y 41jIf
TRUNK PERMIT NO.
STATE
REGISTRATION NO. C0U.NTY ROAD PERMIT NO.LEGAL
2 y 2 S b
DESCRIPTION LOT N0. / STATE ENCROACHMENT
_ PERMIT NO.
BLOCK TRACT �� INDUSTRIAL
NO.OF BLDGS. WASTE APPROVAL
SIZE OF LOT � � NOW ON LOT CHARGES
USOF
1 • ,{�
BUE DINGS� d I CONNECTION CHARGE FEE r----�
NO. DESCRIPTION OF WORK Q FEE
HOUSE SEWER CONNECTING TO IREIMBURSEMENT FEE
PUBLIC SEWER0•$ 3.50 3 j RECEIPT NO. DATE I BY
TING
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
'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 DEPTH
CESSPOOL—DRYWELL 7
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE ,, //
1 J 4� PI /Vi LOWER
TYPE OF CONNECTION r LENGTH FROMV
OWNERS PERMIT $ 1 00 CURB �Py__ M.L.TO P.L. 20
AUTHORIZATION TOTAL FEE :11 S6
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'SSIGNATURE DATE
.,
SIGNED THIS-
i. + NEW HOUSE SEWER P Ib-< -s-
/ DAY OF I9 :• ,
OWNER ORP /s
CONNECT ADDITIONAL
OWNERS AGENT ?�'..y ),m-�'+ ..�o .. BUILDING OR WORK
ADDRESS / �?-:- �" l". d SEPTIC TANK SEEP.PIT(S)
::...............-s, - - -• AND/ORDRA NFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
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 PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL--PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S)[:] CESSPOOLS
SIGNATURE
OF PERMITTEE-- - ----------------------------
T6A642D 663 1/53 �� 9 - f a 6