HomeMy Public PortalAbout6136 IVAR AVE_Sewer__ 76A64 4/72 APPLICATION
� pp ,,�/-+� qq,, ww�� O/� -
�76A642L Pi��L�.O'Ls/�1�8®It'I �4�I'� PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION BUILDING rv� qn
ADDRESS ��(// -y'- {
LOCALITY �I!/ -/`• �I/ '
FOR APPLICANT-T-6—FILL lid NEAREST
CROSS ST. d I
LEGAL /Mtog91I
DESCRIPTION LOT NO. OWNER /� /
MAIL
BLOCK TRACT D ADDRESS
NO, OF BLOGS,
SIZE OF LOT NOW ON LOT CITY AC 4 (1/ TEL. NO.
USE OF
BUILDINGS DISTRICTN0. GROUP 8K MAP PROCESSED BY
��
CONTRACTOR U P ���!' SP�� RPG_7
ADDRESS CONNECTION DATA /
CITY l .d TEL. NO.{� �" D�O STATION /� • DEPTH
STATE LIC /` �J MANHOLE REFERENCE J S SKKGJJ� U ER
LICENSE No.
�� GLASS (,.,- `L �( �fLs s a LOWE
b
NO, .DESCRIPTION OF WORK FEE TYPE OFCRB'TION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. -
PUBLIC SEWER @
SEPTIC TANK,SEEPAGE PIT OR P.C.NO. Q
CO.IMP. NO. JOB NO.
PITS AND/OR DRAINFIELD @ --- /] O
HOUSE SEWER CONNECTING TO TRUNK NO. ROAD PERMIT NO. L)
PRIVATE
PRIVATE DISPOSAL SYSTEM @ s w
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAi YER EASEMENT RECORD. INSTR.NO. DATE O
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT.DRAINFIELD V
EXTN.,CESSPOOL.DRYWELL.MANHOLE @ 11J
ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING d
SEWER OR DISPOSAL SYSTEM G h
..jS TATE NCROACHMENT
PERMITENO:
INDUSTRIAL
WASTE APPROVAL
• CHARGES
OVINER'S PERMIT S
AUTHORIZATION TOTAL FEE 0 CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF ?,6 J
OWNER OR NEW HOUSE SEWER `
OWNERS AGENT
CONNECT ADDITIONAL �
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS .CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I' AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWN OF, AND-INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDE IA PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE Com' SEEP.PITS) ❑ CESSPOOLS ❑
VALIDATION
CK. M.O. CASH
8 4 4-1`7cw27 :% 0 u 5.0 J ..c