HomeMy Public PortalAbout6148 IVAR AVE_Sewer__ i
DEP !FrlVNT OF COUNTY ENGINEER SEWER-SEW-70M DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
' COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING / I �� NEAREST
ADDRESS _���.////----------7 �j f J CROSS ST.
LOCALITY ��.Yy� DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A 7,C. (O�/ S
CROSS ST. RECEIVED BY Ready for Inspection DATE ISS.U.sE{a
OWNER
�Z Z ./
MAIL USEZONE OCCUPANCY 7 MAP
ADDRESS I BK PG
CITY
CONTRACTOR
CO.IMP.N0.
ADDRESS L
JOB N0.
CITY/ -'7TEL.NO. TRUNK PERMIT N0.
REGISTRATION NO. Lf 2 TATE
3 COUNTY ROAD PERMIT NO. 6S'7_2-
LEGAL DESCRIPTION LOT NO. „SQ L Q� �d SERMIT NO.ENCROACHMENT
BLOCK TRACT 4� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE OF •
BUILDINGS 17 E3sts1'-C' CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC_SEWER (@ $ 3.50 RECEIPT NO. I 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 NO- 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 DEPTH
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 MA UPPELZ
R EFERENCER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB �% P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE L-
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE APPROVALS INSPECTOR'S SIGNATURE DATE
PP7UBLIC SEWER
SIGNED THIS____--_J_-_____DAY OF___ _... ------ _---_-.__14NEW HOUSE SEWER
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT._.. _ =____ __ BUILDING OR WORK
I�_�,, .....
ADDRESS .L- __. .cSLY"G SEPTIC TANK.SEEP.PIT(S)
% AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ T S APPLI- CESSPOOL❑ DRYWELL E]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 I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. jACKFILL SEPTIC TANKS O y L
SIGNATURE
SEEP.PIT(S)� CESSPOOLS
�. ,_/-- __ -
OFPERMITTEE.___
Ls�- 4 -------
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