HomeMy Public PortalAbout6267 HART AVE_Sewer__ IDEPA1tPMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITf:T
BUILDING , 6267 North Hart Ayeo D CNEAREST
ROSS ST. I ^ _1� (�
ADDRESS t'���f:�{)�� T��e
LOCALITY Temple Cityfl Califm DISTRICT N0. SERIAL NO. PERMIT N0.
NEAREST 6 A K S
CROSS ST. j,nrigdAn Ave, R CEIVED BY Ready for Inspection DATE ISSUED
OWNER Alice Lo & Hazel MoJones e 1- - AOAZ i
MAIL
ADDRESS 6267 North Hart Aveh $ USE ZON OCCUPANCY BK'MAP PG
CITY Tem le Cit-_V TEL-!S- ,n I I 8
CONTRACTOR
CO.IMP.N0. e
ADDRESS r
JOB NO.
CITY E 0
TRUNK PERMIT NO.--
0
0—❑ STATE
REGISTRATION NO. r ❑ COUNTY ROAD PERMIT N0.LEGAL
DESCRIPTION _ LOT NO. 03 � STATE ENCROACHMENT
201; ®�
� PERMIT NO.
BLOCK ,e,e TRACT �q0� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT0 X 100 NOW ON LG" BLOTS
one �.;� - CHARGES
USE OF
BUILDINGS Ragi danna & garage CONNECTIO CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBL_ICSEWER @ $ 3.50 2 :541 RECEIPT NO. DATE
HOUSE SEWERCONNECTING'TO
PRIVATE DISPOSAL SYSTEM , 1.00 -
CONNECT ADDITIONAL BLDG,OREXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTEROR_REPAIREXISTING! NO DATE BY J
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 14* 5 DEPTH
CESSPOOL—DRYW ELL.
SPECIAL CONDITIONS ONLY: 2.00 Gn 1 MANHOLE REFERENCE'
K. SA C� 4UPPER5 UQ3NER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 � CURB s M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 1 14 'r-S{,
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS-. .21 D O _Sep ember .19-53 NEW HOUSESEWER
,�/�
41t "
OWNER b-Ho/�F (� f� CONNECT ADDITIONAL
pyy"M -*8ew ___• BUILDING OR WORK
ADDRESS--626.{_--N-_Hart----� _8_Q-¢T".- eSEPTIC TANK,SEEP.PIT(S)
AND/ORD RAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[-] DRYWELL I]
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 COUNT
AND STATE OF CALIFORNIA OR THAT I AM THE LEGA OW - ABANDON HOUSE SEWER
ER OF THE ABOVE D RIBED RESID AL PROPERTY. BACKFI LL SEPTIC TANKS E]
SIGNATURE SEEP.PIT(S)[:] CESSPOOLS /1-'�®'
OF PERMITTEE-- >
76A642D 663 1/53