HomeMy Public PortalAbout9235 HECLA AVE_Sewer__ _76A6420 A ® gyA T I® m®R PERMIT .
S a E-663 12.54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 9 SPOSA L
Department of County Engineer
County of Los Angeles BUILDING ® _ ^� r 1 !71 WM.J. FOX, COUNTY ENGINEER ADDRESS 7CASSATT D. GRIFFIN,SlUP'T OF BUILDING LOCALITYFORAPPLICANT TO FILL IN NEAREST 7 ` y -
--y CROSS ST. /� ks
LEGAL / . Ao1dA'1DESCRIPTION LOT NO. OWNERBLOCK TRACT / -%+ MAILADDRESSNO. F BLDGS..SIZE OF LOT NOW ON LOTCITY t.A_ � TEL
USE OF f
BUILDINGS A y, ,[� Q - _1�.�e�L$Yq�. DISTRICT.No. GROUP MAP
BK PG
CONTRACTOR
ADDRESSlyj"jr'pj - '- _� � - CONNECTION DATA
CITY l TEL. NO.
!!! � STATION
� DEPTH
t STATE i� ��. ` �.--17 R MANHOLE REFERENCE ._..
REGISTRATION NO. ( "�`,� 1 �� ❑ COUNTY ._IJ ? i R /I UPPER L-GW.tR
TYPE OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE YI _GURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO '
,PUBLIC SEWER Q $ 3.50 3 So
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _ •^
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. - -JOB—NO.
WORK TO HOUSE SEWER -1.00 _
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT.NO. ROAD PERMIT N0,
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
ANC/OR DISPOSAL SYSTEM 1.06 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
--PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL ,
_CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
omrNER'S PERMT $ 1 00
AUTHORIZATION TOTAL FEE 1 510 REIMBURSEMENT FEE
TRACTORHAVE TTOS DATE CONNECTNTRACTED WITH. THE HEREIN THE'ABOVE DESCRIBED EXISTINGMED CON-DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC'SEWER _ e
NEW HOUSE SEWER
SIGNED THIS I � DAY OF 0-1-+, 19 1 'kt f. 1gS f1 P� rd tr
OWNER OR 7 CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS V SEPTIC TAMS, SEEP, PIT(S)
AND/OR DRAINFIELD
.1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY-ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING ,AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCABANDONNHOUSE SEWER
CALIFORNIA'OR THAT, I AM THE LEGAL OWNER.OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PITS) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE 4
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION 1,
U� c3 v BY1(-1 GCT 1 3 4 4.S � L�
BY
DEPUTY DEPUTY
BY BY .
® DEPUTY' I. �..,.,'.Yx' ,f",��'•"`�' `�- DEPUTY