HomeMy Public PortalAbout6202 IVAR AVE_Sewer__ .IDEPAKTIVENT OF COUNTY ENGINEER SEWER—SEWAGE_ DUSPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGEL S
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILDING NEARESTy7
ADDRESS 19202 NO lyay CROSS ST. V
LOCALITY �'67CI1zJ1A City DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST d �® A 9�
CROSS ST. Gand ba7.ft CEIVED B Ready for Inspection DATE IS8UED
OWNER Frank L9 ��tIV�N �� , - 3-5
MAIL
ADDRESSy[elft 2 III, gr$�` USE ZONE 07UPANCY MAP
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CITY ��xCi1oD�® TELAO. At �74096
CONTRACTOR
G► oGeorge
Knoll g �be1C°g ' CO.IMP.NO.
ADDRESS �.�6�® kVo �Ci� ®$b��t ®�c� JOB NO. —�
CITY �'®�„�® TEL.NO. At 6.�%� �_ TRUNK PERMIT NO.
REGISTRATION 4 CL.RR T AAAr% - COUNTY
y ROAD PERMIT NO.LEGAL
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DESCRIPTION L;91Lot . t70f STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT CA/1.A WASTE APPROVAL
DUSTRIAL
SIZE OF LOT 50OF
pp,��o 1�yyCdO�a��`I�NOW ON LOTS �j�e CHJRGES
BUILDINGS M �Zd�� (� gD”
CONNECTION CHARGE FEE
NO. DESCRIPTION OF V®B� RK FLEE v�
HOUSE SEWER CONNECTING TO _//'�� REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 � C.J RECEIPT NO. I DATE I BY
NECTING TO
HOUSE SEWER CON
PRIVATE DISPOSAL SYSTEM 1.00,
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. �. NBATE _ I 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 1��`(p DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / 39,3 / MANHOLE REFER
m 6--/
_—/f LOWER
T_IPE OF CONNECTION LENGTH FRM! /
OWNERS PERMIT $ I 00 CURB -9= ' M:L.TO P.L. Z-
AUTHORIZATION I TOTAL FEE S '
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER t
SIGNED THIS. ' c NEW HOUSE SEWER
` -DAY OF. - 19.E S
OWNER OR �J 1 _ X CONNECT ADDITIONAL
OWNERS AGENT�� ^ " °" " » 41�la'� BUILDING OR WORK
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�.ry...... -------- ----------v_--s>`;: --.,---------- '
ADDRESS..._.� !:-S�.-e`--!!r--.--�.1"---- .............................-... SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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. 11 SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THU'LEGAL OWN-
ER OF THE ABOVE D SCRIBED RESIDENTIAL,,PROPERTY.' BACKFILL SEPTIC TANKS g
' A.?
d` 'C SEEP.PIT(S)F] CESSPOOLS(k �G Q-G �O
SIGNATURE .__! t}�0.. .i 'y....
`OF PERMITT�.. . --.....................
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