HomeMy Public PortalAbout4834 HELEO AVE_Sewer__ DEPARTMENT OF COUNTY ENGEVEEP. SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
'WILLIAM J. FOX, COUNTY ENGINEER I ADDLDING
RESS
t OR APPLICANT TO ILL IN LOCALITY �� IC, C,,;1�
BUILDING' NEAREST /
ADDRESS Q - �j CROSS ST. !V A AUS cf; 147—IJSIQ :GAY
LOCALITY,�---k3 L ,L�� Y DISTRICT NO. SERIAL NO. PERMIT NO.
CROss ST . ur-�� �} a ✓ S A /332-./ /0575 S
�A i RECEIVED BY Ready for Inspection /DATE ISSUED
-OWNER fj .h.�``rY 1 Y I s-&
MAIL / USE ZONE OCCUPANCY . MAP
ADDRESS '' y► �" BK PG
am+
CITY ell Pi
Lg C114LIJ� ®- -
CONTRACTOR CO.IMP.NO. r"G/(� � (�
41/
ADDRESS i. JOB.N0.
CITY EL TRUNK PERMIT NO.
. ` Q.STATE
Nfi/ OQOUNTYREGISTRATION POAO PERMIT NO. 2.y/7
77 I
LEGAL' STATE ENCROACHMENT
DESCRIPTION LOT N0. c - PERMIT NO.
BLOCK. TRACT INDUSTRIAL
�.^ WASTE APPROVAL
SIZE OF LOT/ro per+ NO.OF BL GS.
(� ^ T NOW ON LOT OF
�� CHARGES
BUILDINGS. ! %.� CONNE TCTC 107d"Cji`ARGE FEE
NO. • DESCRI TP ION OF WORK FEE
REIMBURSEMENT FEE -
HOUSE SEWER CONNECTING TO
0- PUBLIC SEWER @-$ mo RECEIPT NO. //INT•EI BY
HOUSE SEWER CONNECTING TO l
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED..
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' I DATE I BY \`
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.0_0_ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/ORDRAINFIELD 2.00 STATION t .1_71, 0 DEPTH'
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER' /�n,� �/ 0.7- LOWER
- TYPE OF CONNECTION/ LENGTH FROM 2 5-I
Y.— CURB I��P.L. M:L.TO P.L.
OWNERS I PERMIT $ I 00 ;
AUTHORIZATION TOTAL -FEE -F-4-S-53,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOWSSIGNATURE. DATE
DWELLING TO THE PUBLIC SEWER
- . 19- // /�q- _. .
SIGNED THIS--------------------DAY OF........................................ , NEW HOUSE'SEWER.. L?ZiJ
OWNEROR //
}�/� CONNECT ADDITIONAL -
f. *.4/o '� /` ,� BUILDING OR WORK
OWNERS AGENT - -D----•--- ------------ �[��'�.�.-_G-/�
SEPTIC TANKSEEP.
ADDRESS .'........__._. AND/OR DRAINF ELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLI" CESSPOOL E3DRYWELL _
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 DISPOSALSYSTEM
i HEREBY CERTIFY THAT I AM PROPERLY REGIST •RED
AND/CR LICENSED AS REQUIRED BY LOS ANGELESC NT DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGA WN- ABANDON HOUSE SEWER
ER OF THE ABOVE 0 CRIBED/Rr,BiQ�NTIAL PROP BACKFILL SEPTIC TANKS
SIGNATURE'' - � SEEP.PIT(S)(] CESSPOOLS❑
OF PERM, - - =•---- --
Mw
76A642D 663 1/53