HomeMy Public PortalAbout10260 LIVE OAK AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUADDREILDING
SS (J
LOCALITY
FOR APPLIC''�e/jj'''�����rr' TO FILL INBUILDING
NEAREST
ADDRESS D� O h `�I �t ® CROSS ST.
LOCALITY LJ , DISTRICT O. SERIAL N0. aaPERMIT NO.
NEAREST I!r-CROSS ST ��0(� A I Q�p 2.2
/ ,G RREECCEIVVEyD>BY Ready for Inspection DAT IISSSU Dr
OWNER i . ,' •+�V ISG 1D 3
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ADDRESS b /G USE ZON OCCUPANCY B I MAP
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CITY e ' TEL.NO. 2p A—
CONTRACTOR
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CONTRACTOR ,/4, 1 I �\
CO.IMP.N0, rl
ADDRESa� �(/� JOB.NO.
CITY r �� iNO.�� / 3
TRUNK PERMIT N0.`��
REGISTRATION NO.le,> S�, COUNTY
ROAD PERMIT N0.
LEGAL ��ss�� STATE ENCROACHMENT
DESCRIPTION LOT NO. �C CA,C-_ PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION GE FEE
NO. DESCRIPTION OF W K FE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER $ 3.50 U RECEIPT NO. DATE BY
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 N0. 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
3 j DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY2.00 CA�MAN REFERENCE
TYPE OF CONNECT�pN , LENGTH FROM
OWNERS PERMIT $ I 1 00 ` � `P M L.TO P.L.
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO/GONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO T`HEpPUBLIC S WER
SIGNED THIS _`,Lj _ _ Y F _. NEW HOUSE SEWER �G�Y'A-6k -1 y ,
(.. .. 19 +
OWNER OR CONNECT ADDITIONAL
OWNERS ASE - BUILDING OR WORK
- - -
ADDRE /��__ &�-�C•�---- ------- -------- SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HE EBY A NOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CAT NO ATE THAT THE ABOVE IS CORRECT AND AGREE
TO COM ITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I 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 THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
T^ v��� SEEP.PIT(8) CESSPOOLS
SIGNATURE a7" /
OF PERMITTEE -- •---------t---------s-----.._._..---••-...........................
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