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HomeMy Public PortalAbout6227 IVAR AVE_Sewer__ " 6 9 E•683 12-54 APPLICATION " FOR PERMIT DIVISION OF BUII.DING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer mm County Of LOS Angeles BUILDING WM. J. FOX, COUNTY ENGINEER ADDRESS pG a� CASSATT D. GRIFFIN,SUPT OF BUILDING - LOCALITY FOR APPLICANT.TO FILL IN C OSSST ,( CROSS ST. LEGAL DESCRIPTION' LOT NO. OWNER - j BLOCK TRACT �� - MAILADDRESS 7 0. NO. OF BLDGS, !� SIZE OF LOT� � /� NOW ON LOT p4. CITY � �i EL. N USE OFt> 't�" BUILDI • sNGS �''" � i DISTRICT NO. I I MAP PG BK ' .CONTRACTOR ADDRESSCONNECTION DATA CITY' J� TEL. NO. STATION DEPTH ❑ STATE _ tl MANH�O4REFERENCE LOWER REGISTRATION NO. ❑ COUNTY TYPE OF CONNECTION LENGTH FROM �� NO. DESCRIPTION OF WORK FEE sY, CURB �,;� M.L.TO P.L 1 . Tf HOUSE SEWER CONNECTING TO SEWER @ $ 3.50 767 - HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR �— CO. IMP. NO. /�J� JOB. N0.' ' WORK TO HOUSE SEWER 1.00 �. ...ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.,? DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT A'ND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL - CESSPOOL-DRYWELL WASTE APPROVAL .SPECIAL CONDITIONS ONLY 2.00 CHARGES PERMIT CONNECTION CHARGE FEE OWNER'S $ 00 - AUTHORIZATION TOTAL FEE O REIMBURSEMENT FEE TRACTORTTOS CONNECT DATE CO ONECTONTRTHEA ABOVECTED WDESCRIBEDITH THE HEREIN EXISTING NAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO. THE PUBLIC SEWER ^--- t HOUSESEWER - SIGNED THIS-1)A AY OF - `,/, � �1�9NEW" OWNER-' OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK, SEEP, PIT(S) - -- - ADDRESS AND/OR DRAINFIELD I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[3 ' AND-STATE-THAT THE ABOVE IS CORRECT AND AGREE.TO-COMPLY WITH ALL COUNTY ORDINANCES AND STATE, LAWS REGULATING ALTER, REPAIR,SEWER OR- 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,AND STATE OF ABANDON HOUSE SEWER. CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE - - - DESCRIBED RESIDENTIAL PERTY. BACKFILL SEPTIC TANKS❑ 7 NEP.PIT(S).❑ CESSPOOLS❑ - SIGNATURE OF PERMITTEE - -- WILLIAM J. FOX COUNTY ENGINEER - VALIDATION - -- ^BY BY _. DEPUTY DEPUTY .. 7' -BY qvp . © 'DEPUTY . DEPUTY