HomeMy Public PortalAbout5524 HILTON AVE_Sewer__ Ilk
�. -" DEPARTMENT OF COUNTY ENGINEER - SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING It h�
ADOq ESS "7JL 14..TO
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OR APPLICANT TO FI IN LOCALITY T.
NG L '/ /�� NEARESTSS �� f CROSSST.ITY / DISTRIC`T N0. SERIAL NOi PERMIT N0. cST - J �� I�l' � `TST. /06� RECEIVED BY Ready for Inspection DATEISSUED
�P�-� USEZONE OCCUPANCY MAP
SS -r_jp�/J SK PG
�� TELAO. `� DACTOR rQ � CO.IMP. NO.SS � JOB N0.��/ TEL.NO. / TRUNK Pff' Fa�^T
r, STATE
LEGAL
REGISTRATION N0. J�O4 COUNTY ROAD PERMIT NO. 24if�G�
STATE ENCROACHMENT
DESCRIPTION LOT N0. .PERMIT NO.
BLOCK TRACTq[�o INDUSTRIAL-
WASTE APPROVAL /
SIZE OF LOT .51 XL 0 NO-OF NOW ON LOT
BULOF
DINGS / S CHARGES
I /
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• �h GC/ CONNECTION CHARGE FE\ /
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ S 3.50 3 RECEIPT NO. �� DATE \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 / HO' DATE BY \
_ SEWER OR REPAIR
EXISTING
SYSTEM 1.00
DISCONNECT AND ABANDON SEWER 7
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION } d r DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 PPER� EFE BENCE
TYPE OFCQN ECTION � LENGTH FROM i
OWNERS PERMIT $ 1 00 w? ,.CUR .ol. M1I.L.TOP.L. Q�
AUTHORIZATION TOTAL FEE Sd /0-5 ,4' oi(� 45N,4„—' ,,W ,4
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PJJBLIC SEWER ` -
SIGNED THIS._.._ DAY OF���':�....__._.. 1-� NEW HOUSE SEWER L p�q� �j
OWNER OR /fF l 'j/� �p� CONNECT ADDITIONAL
OWNERS AGENT[�!. ._...._1���Fsc.:_=.�-! __..._ BUILDING OR WORK
Y7/'F-'�/�/-` SEPTIC TANK,SEEP.PIT(S)
p w/ J.!
ADDRESS... il.._e�1.._/S.G..�Y......__ .. ...._.... .Y'..'...._........__... AND/OR DR AINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL DRYWELLE
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
ANO/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 ABOVE DES RIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS )
SIGNATURE //+f // SEEP.PIT(S)� CESSPOOLS 0 �3a�
OF PERMITTEE.../^C�.. . _.,�,r! ---------
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