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HomeMy Public PortalAbout6109 IVAR AVE_Sewer__ f DEPAUTMENT OF COUNTY ENGINEER, ' SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER I BUILDING ADDRESS �(J / r 1/ �P• /FOR APPLICANT TO TO FILL IN f LocaLITY T C . L —/ ADDREBUILDSS : Fi r Be y- W. 'N �7 R„a !'il' 6/ ' CROSS ST. . � LOCALITY DISTRICT N0. SERIAL No. PERMIT NO. NEAREST A 3933-3s CROSS ST. • Ready for Inspection p�DATE ISSUED, OWNERMAIL �d Aj'M " �1�++. Y • �t/ "� 7 A DRESSY��4 9� G,i t�/�� 11SE 7,ONE OCCUPANCY BK MAP PG�J CITY `l ✓6��i L.NO. �^ .�O f/ /� /•F I I44 / CONTRACTOR e� CO.IMP.N0. ADDRESS �tOQ chi ® Irh yy-- .A JOB N0. - CITY psQ TEL.NOX �4 P 60 TRUNK PERMIT'NO. H STATE REGISTRATION NO. r v O COUNTY_ ROAD PERMIT NO. � �9 a LEGAL =r � j STATE ENCROACHMENT DESCRIPTION LOT N % PERMIT NO. BLOCK TRACT®. INDUSTRIAL �/ WASTE APPROVAL SIZE OF LOT g��/�y �au` N0.OF BL T NLOT CHARGES NOW ON w USE OF BUILDINGS , " �"O�O' �- CONNECTION C-HWGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE _ PUBLICSEWER @ $ 3.50 RECEIPT NO. I DA: ' _ IBY HOUSE SEWER CONNECTING TO ®� PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OREPTION RECORDED WORK TO HOUSE SEWER 1.00 N0. ALTER OR REPAIR EXISTING DATE BY _SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM' 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR / PITS AND/OR DRAINFIELD 2.00 STATION S CESSPOOL—DRYWELL 9. DEPTH SPECIAL CONDITIONS ONLY 2.00 MA HOLE REFERENCE 1 �rJ r U�AE,p LOWER _ ­-.-CURB PE OF CONNECTION LENGTH FROM OWNERS . , PERMIT 1 00 Y. CURB P.L.-M.L.TO P.L. AUTHORIZATION I TOTAL FEE �j Q 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING" APPROVALS INSPECT O S�$IGNATURE DATE DWELLING TO THE PUBLIC SEWER /J I SIGNED THIS.....................DAY OF.....--.... ...........................19... ... i NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS. AGENT- �/ :. / ,p.. .....-......._ BUILDING OR WORK ADDRESS. �© ckX6C.t_.-.Ld !.'`4....k:'Y,k.......-.........-_... AND/ORDRAINFIELDS EPTIC TANK.SEEP. IT(S) l� 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL 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 LAN /OR Y CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND CENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- E ABOVE DESCRIBED RESIDENTIAL PR ERTY. BACKFILL SEPTIC TANKS SEEP.PIT(S)C] CESSPOOLSE TEE-- — -..:......... -..... ....... / 76A642A 663 7/53 v