HomeMy Public PortalAbout6258 HART AVE_Sewer__ y
DEPAIt'rMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
OF BUYLDING AND SAFETY PERMIT APPLICATIONCOUNTY OF LOS ANGELES n
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESSBUILDING �- I Y t a / !
FOR
/APPLICANT.y(.TO FILL IN LOCALITY
ADDRDE`SBU'LS NEAREST L
CR SSST. -gy m
LOCALITY ' DISTRICT N0, p. '.SERIAL NO. PERMIT NO.
NEAREST J �� „ � S
CROSS ST. GT
ECE V.ED B Ready for Inspection DATE ISSUED
OWNER
MAIL _� ml,
ADDRESS /q`Gf/7/(1 USE ZONE OCCUPANCY BK MAP
CITY 0 TEL.NO. (J ,
CONTRACT R U
_ CO.IMP.NO.
ADDRESS e =�
JOB NO.
CITY TL. '
ATE
TRUNK PERMIT N0.
❑❑ ST
REGISTRATION NO. -7 ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
� PERMIT NO.
BLOCK TRACT uri�Jj D L INDUSTRIAL
/ WASTE APPROVAL ---
SIZE OF LOT SC, NOW ON LOTS , CHARGES
USE OF
BUILDINGS CONNECTION CHARGEE
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
REIMBURSEMENT FEE
' PUBLIC SEWER @ $ 3.50 v� RECEIPT NO. I NDATE BY ±�
HOUSE SEWER CONNECTING TO \7f
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIONjREOORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- ATE) .I 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 G /
CESSPOOL—DRYWELL 1.6
SPECIAL CONDITIONS ONLY 2.00 / IM A HOLE REFERENCE
TYPE OF_CCONN`tCTION LENGTH FROM /
OWNERS PERMIT $ I 00 /CURB/ 4ur. M.L.TO P.L.
AUTHORIZATION TOTAL FEE ,S'6
I 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 i
SIGNED THIS.. y:t._.-..DAY OF------- ......................19 NEW HOUSE SEWER
OWNER OR t CONNECT ADDITIONAL
OWNERS AGE -------•-----•--- •---....----•---� ---•---
__ BUILDING OR WORK
-1(. SEPTIC TANK,SEEP.PIT(S)
ADDRESS. .... ------_-----................._... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CAT11
ION 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 I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG I ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- )
ER OF THE ABOVE D IBED ESID L PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE ; SEEP.PIT(S)E] CESSPOOLS dell-�'
OF PERMITTEE---- - -1
76A642D 663 1/53 j
1.