HomeMy Public PortalAbout6236 IVAR AVE_Sewer__ S&E-683 3-55 APPLICATION. FOR PERMIT
DIVISION OF•BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL —
Department of County Engineer
County of Los Angeles BUILDING
MOM=
SSWM.J. FOX,COUNTY ENGINEER � a® CASSATT D.GRIFFIN, SUPT OF BUILDING ITY f`1_ f/�. /N �1i(f• t��' 'r �
I FOR APPLINEAREST
CANT TO FILL IN CROSS ST. 1 LJJK d4F
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LEGAL ` I �R r C.?. D
DESCRIPTIONI [OT NO.�J D Z OWNER 'Ayl C-ei/ �y S
BLOCK t,TRACT /' °�~� ..! ADDRESS
r✓D / y/(/�
SIZE OF LOT ./JO•)L /J-�' NO. 0 LDGS. CITY �AI/j e TEL. NO.Q�C! '/f 6
NOW 16 LOT
USE OF
BUILDINGS 1/-' DISTRICT NO. GROUP BK MAP PG
CONTRACTOR
ADDRESS °,G5�/� a'� COv�NNECTION DATA
jJ
I
CITY �+ TEL. NO.16 �Q�•!'�L' STATION2 .'?� 6
.+ 6 �� DEPTHEl STATE
�• !f' UPPER
G ❑ COUNTY MANHOLE REFERENCEA �ryL1el
_ �
REGISTRATION NO. 61 of C�� J
NO. DESCRIPTION OF WORK FEE O
TYPE OECTION LENGTH FROM
HOUSE SEWER CONNECTINGTO ,D Y. (CURB' P.L. M.L. TO P.L.
PUBLIC SEWER Q $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. h JOB NO.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.3
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/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
CONNECTION CHARGE FEE
OWNER'S PERMIT $ t 00
AUTHORIZATION TOTAL FEE 50 REIMBURSEMENT FEE
TRACTORTTOS CONNECT THMED CON-
EDESCRIBED EXISTING
CONTACTEDDATE ABOVE DA DWELLING APPROVALS DATE . INSPECTOR'SSIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS i �DAY OF�/�^ 19.- ��. _ — 6-.i- //• �..ch�s/
OWNER OR NTI r�� )1/�/�,r/�` CONNECT ADDITIONAL
OWNERS AGENT., �/ r vt✓r BUILDING OR WORK
•� SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL-❑ DRYWELL❑
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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL
SIGNATURE
-. �Q CESSPOOLS '
OF PERMITTEE � - -
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLEIG. INSPECTOR
5 1 0 31 APR 16 4 4.5 0 to