HomeMy Public PortalAbout10528 KEY WEST ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENaINEFR - I ABUDDREILDING L� .^ r( _
SS (�+ ✓ 1,a ��,w
FOR APBUILDING3PLICANT CTO_FILL IN ( LOCALITY
ADDRESS S� f F �r� V CROSS ST.
LOCALITY �L• DISTRICT NO. SERIAL NO. PERMIT[/NN�'O!.
NEAREST /� ,�/ A /I g 4G� S
CROSS ST � <
RECEIVED BYReady for Inspection ( DATE ISSUED
OWNER //Jyv( 4l&0r j— / il
MAIL USE ZONE OCCUPANCY MAP,ADDRESS
"-�G�,,� / ,p �0 BK PG
CITY vmr/ f-G< Gam/ 0. A t%
CONTRACTOR i /
CO.IMP.N0. f
ADDRESS L� 9 /�,
yy JOB.NO.
CITY izig� _a7 j TEL N0. �t7 f TRUNK PERMIT N0.
TATE
REGISTRATION NO. � �� COUNTY ROAD PERMIT NO
LEGALSTATE ENCROACHMENT ® '
DESCRIPTION) LOT NO CQ r PERMIT NO Jy�
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT�� NO.OF BLDG3 ! \ CHARGES /
NOW ON LOT
BUIOF
LDINGS � CONN ECTION`CHARGEFEE /
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $ 350 RECEIPT NO `I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R CORDZe
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO D TE
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 /+ F811 t DEPTH 6
CESSPOOL-DRYWELL / ANHOLE_R FERENCE
'.P;N-U,P P_E
SPECIAL COND9TIONS ONLY 200 I� LOWER
yi R
TYPE OFCURB ECTIO�C_ MEL TORPFR
L OM
OWNERS PERMIT $ I I 00 "7
AUTHORIZATION I TOTAL FEE _
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TFPJUBLIC SEWER
SIGNED THIS_______ _ _DAY OF---- __ � ___-_�.__________19`�-3 NEW HOUSE SEWER
OWNER OR �- CONNECT ADDITIONAL
OWNERS AGENTw"'"`�� -- BUILDiNGORWORK
- - - - -
?4747?
JS Z SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
ADDRESS _ . ___ . __
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL I]
CAT
IONAND 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 1 AM PROPERLY REGISTERED
AND/OR LICENSED ,REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CAL ORNIA OR TH#D I M TNE LEGAL?'PROPERTY.OWN- ABANDON-HOUSE-SEWER BACKFILL SEPTIC TANKS
ER OF THE ABO ES bb[
SIGNATURE
SEEP PIT(S)E] CESSPOOLS
� r3
OF PERMITTEE--------
-
76A642D 663 1/53 491411,