HomeMy Public PortalAbout6231 IVAR AVE_Sewer__ • DEPARTAIFINT OF COUNTY ENGnvEER SEWER—SEWAGE ®BSPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
' COUNTY OF ]LOS .ANGELES \- M'
WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS 3 J
FOR APPLICABUILDINGNT TO FILL
JIN. LOCALITY _2,,0_,,j/j4 zlej_ s
NEAREST
ADDRESS CROSS ST. �il�✓1 '/Gf filA!
LOCALITY A DISTRICT N0. PEgRIAL(NO.
C� PERMIT N0.
NEAREST /�,
CROSS ST. r75 4,,jA jf( i(,/vlri �'wJh RECEIVED BY Ready for Inspection DATEISSUED
OWNER /1 Kl 1P`'I�i(-P�� c
MAIL USE 20NE OCCUPANCYMAP
Z61-ADDRESS xC..�.�Y�/\ q- BK PG
CITY �/�AJ : TEILNO. � '7 (D
CONTRACTOR _ r1 CO.IMP.NO. 3 3
ADDRESS JOB.NO.
CITY TEL.N0.01 —9/;15'. TRUNK PERMIT NO.
❑ STATE
REGISTRATION NO. j V ❑ COUNTY ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT Q INDUSTRIAL
WASTE APPROVAL0-OF BLD6
SIZE OF LOT6-0 NOW ON LO/TS� CHARGES11-00
USE OF �� / /� u� .
BUILDINGS l
l4 /�I y�/1r CONNECTION CHA E
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER CD $ 3.50 RECEIPT NO. DATE Y
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. I DATE 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 DEPTH
CESSPOOL—D RY W ELL r
SPECIAL CONDITIONS ONLY 2.00 / "�/✓�' O �►MA`U pE R EFERENCE
Y TYPE OFCURB
COfJNECTIONP.L. MEL. TO P.L.NGTH
OWNERS PERMIT $ I 1 00 O
AUTHORIZATION I TOTAL.TEE
I HAVE THIS DATE CONTRACTED_WIT.H,THE HEREIN NAMED
CONTRACTOR TO CONNECT THE A'BOVE:DESCRIBED EXISTING APPROVALS INSPECTO.R'S,SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER, -
SIGNED THIS----.____.____ ..DAY OF... NEw HousE SEWER ������✓,,__ �d���
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT...................................................................... , BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..............._......_..--___.........._--__----_.._.._..__.._..._.._..--_.--._... AND/OR DRAINFIELD
I 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. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AMPROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E3
/f SEEP.PIT(S)E] CESSPOOLS❑
SIGNATURE /J \JrYZ/OpY-I,----,
OF PERMITTEE.............=...._
76A642A 663 7/53