Loading...
HomeMy Public PortalAbout6261 HART AVE_Sewer__ DEPAWrNC )NT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT .APPLICATION COUNTY OF LOS ANGELES ^ WILLIAM J. FOX, COUNTY ENC3INEER I BUILDING ADDRESS FOR APPLICANT TO FIL IN LOCALITY BUILDING NEAREST ���~ V ADDRESS (, C.� / „ CROSS ST. /LOCALITY DISTRICT DISTRICT NO. `SERIAL NO. PERMIT NO. E A NEAREST f� CROSS ST. �,-� � �- aX" RR)ECEIVED�BY Ready for Inspection DATEISSUED / OWNER a 4� � MAIL ADDRESS /• k USE 20NE OCCUPANCY BK MAP G CITY may+ /o pyo � �V TEL.NO. CONTRACTOR � CO.IMP.NO. 1� O ADDRESS " Ci 9 7 JOB N0. CITY A, ,�Y TEL.NO. o TRUNK PERMIT NO. [TATE REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO. �n C? C{ I LEGAL Q al °)®4 STATE ENCROACHMENT DESCRIPTION LOT NO. Q 7 °[ PERMIT N0. BLOCK TRACT o 9 INDUSTRIAL WASTE APPROVAL C(© NON SIZE OF LOT ( NO.OF BL JSC`� ON LOOTT CHARGES ' USE OF {t "� BUILDINGS �� •p ,\, �"/\G CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PU _.j BLIC SEWER @ $ 3.50 J d RECEIPT NO. I�D'ATE I BY 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 N0 DATE 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 CESSPOOL-DRYWELL SPECIAL CONDITIONS ONLY 2.00 T� MANHOLE REFERENCE MPPER- LOWER TYPE OF_COMNECTION _ LENGTH FROM �--� OWNERS PERMIT $ I 00 rCURE� --je==z M.L.,TO P.L. •8 AUTHORIZATION TOTAL FEE ,�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 PUBLIC SEWER ��`` C l ,y 31 Y, NEW HOUSE SEWER G/ -Aro r SIGNED THIS----./.�.._--DAY OF.--.../;.--.••-__-____�-/..:...........19__.x.. OWNER OR e ' (/ d1���fJ� CONNECT ADDITIONAL OWNERS AGENT i�AOAYYI�,.'_Q_-___.!•_-f�a-ZJ_.f .RD BUILDINGORWORK ADDRESS _f -��n vr�_ SEPTIC TANK,SEEP.PIT(S) ---oy-;""', -- ••-----•--- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVErREADrTHIS APPLI- CESSPOOL❑ 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 1 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 AM THE LEGAL OWN- ER OF THE ABOVEJD SC ED sRESIDENTI PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE �" �j /lF f SEEP.PIT(S)[:] CESSPOOLS t OF PERMITTEE---_.... -_ - - 76A642D 663 1/53