HomeMy Public PortalAbout6273 HART AVE_Sewer__ DEPAI rMrENT OF COUNTY-ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES.
WILLIAM J. FOX, COUNTY ENGINEERI BUILDING
ADDRESS 7 Q1
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Ave , ;
FOR APPL CAN TO,FI L.IN LOCALITY77CI
,BUILDING �
NEAREST
DDESS. l 1 /14461
CROSS ST. Y-\
LOCALITY �' -�_.- DISTRICT NO. SER AL NO. PERMIT N0. c
`NEAREST A S
S5
CROSS.ST. �.. ��'. 1
�./�+ Lj CEIVED BY Ready for Inaoection DATE ISSUE
OWNER V C�Yl �.e :AJG.ol�LCN c fW
MAIL-
ADDRESS la:2'79 No !f�`V� USE ZONE OCCUPANCY I `MAP
CITY ;. TEL.N BK PG
CONTRALTO
_ 0.IMP.N0.
ADDRESS
JOB-NO.
CITY EL. 0 TRUNK PERMIT NO.
REGISTRATION N ❑ STATE
_ ❑ COUNTY ROAD PERMIT NLEGAL I
.
DESCRIPTION LOT NO. �°.1 X0-4 1 STATE ENCROACHMENT
` sPERMIT NO.
BLOCK TRACT • INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. -
NOW ON LOT CHARGES
USE OF
BUILDINGS t-�rla--�-ic J/�j ij�3��1 CONNECT N`HARGE FEE
NO. DESCRIPTION OF WORK F,EE
HOUSE SEWER CONNECTING TO REIMBURSEMENT=F
PUBLICSEWER @ $ 3.50 RECEIPT N I� TE I BY
HOUSE SEWER CONNECTING TO' ,
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDE�
WORK TO HOUSE SEWER- 1.00
ALTER OR REPAIR EXISTING - NO DATE I BY
SEWER OR DISPOSAL SYSTEM �r 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTICrTANK,SEEPAGE PIT OR-
PITS AND/OR DRAINFIELD' 2.00 STATION Q DEPTH <,
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00MANHO EFERENCE
L- S4PER-
= TYPE OF CONNECTION LENGTH FROM a _10 f
OWNERS PERMIT $ 1 00 _Y (jCURB sP.1.'� M.L.TO-P.L.
AUTHORIZATION TOTAL FEE }�
1 HAVE'THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THR
E-'ABOV DESCRIBEA,EXIsT�ING
DWELLING TO THE PUBLIC�,SAPPROVALS INSPECTOWSSIGNATURE DATE
E.WE6w
SIGNED THIS---.'2DAY OF.. . i... -..19�.? NEW HOUSE SEW ER S A
OWNER ' OR sc CONNECT ADDITIONAL
OWNERS AGENT ................. ---- ........... BUILDING OR WORK
ADDRESS�'....1_ - ---- - ----- ---- _ _ _-t_Y e "SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY•'ACKNOWLEDGE THAT I HAVER D THIS APPLI= CESSPOOL E] DRYWELL E
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 A D SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY.,-,THAT I AM PROPERLY',REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED-AS REQUIRED -BY LOS,ANGELES COUNTY DISCONNECT
ABANDON HOUSE SEWER
AND
AND STATE OF CA'L'IFORNIA OR THAT I AM,THE LEGAL OW -
ER OF THE ABOVE,DE IBED SI[ rIQ71AL PROPERTY. BACKFILL SEPTIC TANKS El
+ SIGNATURE / - SEEP.PIT(S)� CESSPOOLS
OF PERMI;TTf E---_
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