HomeMy Public PortalAbout6021 IVAR AVE_Sewer__ ... D
5&E-663 I2-66 B N Il -PERMITAPPLICATION.-FOR
S>}E•6h�
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles ;L77
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CAD D �
WM.J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING - 1 '
FOR APPLICANLEGAL `TT ATO FILL IN ROSS T
DE CRIPTIOti LOT NO. c:::r 6 L/ 1 - OWNER S QDAS
BLOCK TRACT l5 0( MAIL
( ADDRESS
N0. OF BLDGS. �{ .�
SIZE OF LOT 1C J�"t� NOW ON LOT .%4i CITY a� TEL.;
USE OF 'TLS
BUILDINGS `�r¢-� ,qy ��1�/"�. DISTRICT NO. Wt'6UP BMAP
PG
CONTRACTOR 1 0 �J �-} �"P Ir_�L y (�I•I I T I f�K
Z...ski 1�
ADDRESS ' �.Lj� CONNECTION DATA
CITY ( /1&A/7� TEL. NO. v ,• STATION 2 , DEPTH
1 -5`7�7 El STATE — /�..� { �. WPOLE REFERENCE
REGISTRATION NO. 6Y �'iiLPER �CIISpER
TYPE O• ECT ON LENGTH FROM /
NO. I DESCRIPTION OF WORK FEE Y. CURB P.L. hI.L.TO P.L. C>
' HOUSE SEWER CONNECTING TO A�
PUBLIC SEWER (g) $ 3.50 Ll �/
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER 7.00 ^� CO. IMP. NO. /_-3 O JOB. NO.
f{ _
ALTER OR REPAIR EXISTING �%�O
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1.00 i 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
pERN1IT
OWNER'S I c
AUTHORIZATION TOTAL FEE -� REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECT R*S SIGNATURE
TO THE PUBLIC SES R
SIGNED THIS DAY OF -19NEW HOUSE SEWER,
OWNER' OR / CONNECT ADDITIONAL
OWNERS A-1 BUILDING OR WORK
SEPTIC TANK, SEEP, PITS)
ADDRESS �' AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[_1DRYWELL❑ -
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 I AM PROPERLY REGISTED AND
LICfENSED AS REQUIRED BY S ANGELES COUNTY STAT O DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 A HE LEGAL OWNER 0 HE-_ BOV ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P OP RTY. BACKFILL SEPTIC TANKS❑
SEEP:PITS) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
WILLIAM J. FO , OUNTY ENGINEER VALIDATION,By By
q
DEPUTY ' DEPUTY
BY BY
® DEPUTY DEPUTY.