HomeMy Public PortalAbout6251 HART AVE_Sewer__ DEPAWTMENT'OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER / q
�' ADDRESS
BUILDING FOR APPLICANT-10 FILL IN LOCALITY
NEAREST
ADDRESS "a.,j /�O .!^T"/��'� CR SS ST.
LOCALITY ei DISTRICT NO. U SERIAL NO. LPERRMIT NO. c
NEAREST / ,S A I/y J_ /1 J
CROSS ST. . p h 4,4 T1 AveRECEIVED BY Ready for Inspection DATE ISSUED
OWNE13�7,O'S,pA le 114 lyl,;Vee4 a TXio,burn. 6-1
MAIL I
ADDRESS (j-.A,,S'/ 14, /J�itpT//�77//� p USE ZONE �j�^ OCCUPANCY BK MAP/PGG
CITY TEL.NO-#r7 4�' 49 V `
CONTRACTOR r CO.IMP.NO. /� V
ADDRESS p ' JOB N0.
CITY TEL.NO f
TRUNK PERMIT NO.
r q STATE
_ V
REGISTRATION NO. d` COUNTY: ROAD PERMIT NO.
LEGALry
'0:z
� � � �r p�� STATE ENCROACHMENT
DESCRIPTION LOT N0. rL PERMIT NO.
BLOCK TRACT �jVo INDUSTRIAL �...
WASTE APPROVAL
SIZE OF LOTC� NO.OF BLDGS.
OQ X /00 NOW ON LT
Z CHARGES
USE OF
BUILDINGS /JQ S r1)&.nd41 1¢' 1<6y0m p— CONNECTION CHARGE FEE �t
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 b RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPT-t N RECORDED
WORK TO HOUSE SEWER 1.00 ' O O
ALTER OR REPAIR EXISTING NO' DATE �I.B�
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 200 STATION I (�{r?( DEPTH Ct}
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 / G MANHgEFERENCE Ilo' LOWER
TYPE OF CONNECTION- LENGTH FROM
OWNERS PERMIT $ 1 001 64%. CURBS ftS M.L.TO P.L.
AUTHORIZATION I TOTAL FEE sl)-6
1 HAVE•THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE FWIC SEWER
SIGNED THIS--2�`-----..DAY OF._..----- -...-.-.-_. 19,✓3 NEW HOUSE SEWER SG y C J -?Q
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT- _. _ BUILDING OR WORK
- -----------•----------------- .-..-----
EPTIC TANK,SEEP.PIT(S)
ADDRESS..-�j?! /----- ---- - ----- -_-- C.....-...----.... ... _� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- ' CESSPOOL I] 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
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 E LEGAL 0 N-
ER OF THE ABOVE DESCRIBED REST IAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)E] CESSPOOLS��< )"o(,mak g-'c o S3
OF PERMITTEE...-....... .-_. --1---- ----- _
76A642A 663 7/53 D/ y-