HomeMy Public PortalAbout6166 IVAR AVE_Sewer__ Yr.
DEPARTMENT OF COUNTY EN SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY
PERMIT APPLICATIOU.
• -
COUNTY of LOS ANGELES
�f WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS ( �+
FOR APPLICANT TO FILL IN LOCALITY
ADDRESS DING 6 �� , VAR
` NEAREST
' CROSS ST.
LOCALITY �-� r 4 DISTRICT N0. SERIAL N0. PERMIT N0.
'NEAREST
5
CROSS ST, co a �_a yg� � A -
rP f,E1V D BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCYBK PG MAP
ADDRESS ��
CITY TEL.NO. I I M
-/
CONTRRIC31R Nnttingham Co. of So. Ca(. CO.IMP.N0. � � 3
ADDRESS 5933 N. CLOVERLY AVE.
JOB.NO,
clry TEMPLE CITY. CIF�D
®� TRUNK PERMIT NO.
T ' A
Fff
STA `�
EREGISTRATION NO. COUNTY TE ROAD PERMIT NO. 4 S T12'1 Z
LEGAL -
DESCRIPTION LOT NO. E) � ST OAGHMENT
_ PERMIT N0. _
BLOCK TRACT '7 (�` INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N OF BLDG CHARGES V
NOW ON LOT ,a
{ - i
I USE OF
BUILDINGS a CONNECTION CH RA GE'FEE_
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO r REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO.a,I.-- DATE +BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
4' CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_WORK TO HOUSE SEWER 1.00 .
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
PITS AND/OR ORA NFIELDT OR 2.00 STATION ,V¢-13 / DEPTH /
.' CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00Zz ANHOLE REFERENCE
LOWER
TYPE OF CONNECTI -LENGTH FROM rl
Y. CURB P.L. M.L.TO P.L.
t OWNERS PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE `S} -
t' .1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR' SIGNATURE DATE
DWELLING TO THE cPUBLIC SEWE
SIGNED THIS...._�.d___.DAY OF.._.. �.._. ...19�`T NEW HOUSE SEWER 2��_
I CONNECT ADDITIONAL
OWNER OR ��il/1�„
OWNERS AGENT._ ._...___.... .. -/ BUILDING OR WORK
/ //` � �� SEPTIC TANK,SEEP.PIT(S)
ADDRESS__(l ._E-k—..� ..�1e4!S!`x� !,t? l_ ... AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE .
-CO-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 DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN•
ER OF THE ABOVE .DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE M. �iOTTIh1GNAM CO OF SO. �•' SEEP.PIT(S)� CESSPOOLS'
OF PERMITTEE------ -------- - -
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