HomeMy Public PortalAbout6047 IVAR AVE_Sewer__ �.:S&E-663 12.54 5UCC I® FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer "
County of Los Angeles 'BUILDING
c 3 y.7 t Y
WM. J. FOX. COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY .
FOR APPLICANT TO FILL IN CROSS ST. ce, a
LEGAL - �°A 1 • 4r
DESCRIPTION LOT NO. r 4 a OWNER 14 1 `f ��G
BLOCK TRACT ��L MAIL
q ADDRESS
SIZE OF LOT NOW00 BLOTS sL-
CITY TEL. NO. 73.7
USE OF
BUILDINGS , DISTRICT N0. I ROUP I MAP
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CONTRACTOR Af ✓ 7
ADDRESS :' CONNECTION DATA -
CITY-- TEL. NO STATIONi DEPTH 1
-STATE 7 MANHOLE REFERENCE
REGISTRAT ON 0. ❑ COUNTY z / � S� UPPER L&UM
--QTY E OF'CONNECTION LENGTH FROM 9�G
NO. DESCRIPTION OF WORK FEE CURB p3. M.L.TO F.L. OC o
HOUSE SEWER CONNECTING TO o
PUBLIC SEWER - R $. 3.50
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
AND/OR DISPOSAL SYSTEM 1.00 -PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS,.ND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL - WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
wkER,S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE .HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I PECTOR'S S/NATURE
TO THE PUBLIC'SEWER .
SIGNED THISNEW HOUSE SEWER DAY 0 � 19 -�ms
OWNER 'OR- CONNECT ADDITIONAL
OWNERS AGENT /�� C.. BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE•THAT I HAVE READ THIS APP (CATION 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY'AND STATE OF DISCONNECT PLUG AND
CALIFORNIA- OR THAT 1 AM THE LE AL OWNER OF TH ABOVE ABANDON HOUSE SEWER - ,O
DESCR RESIDE f L dB�ERTY. BACKFILL SEPTIC TANKS❑
••••••�����IIII SEEP:PIT(S) ❑ CESSPOOLS: •,��' Z
SIGNA e
OF PERMITTEE
WILLIAM J. FOX, d6VNT1Y ENGINEER VALIDATIOpN
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BY By
DEPUTY DEPUTY '
BY BY
-,® DEPUTY _ DEPUTY�-