HomeMy Public PortalAbout10274 LIVE OAK AVE_Sewer__ DF.PARTIUENT OF COUNTY ENGWEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY of tos ANQELEB :.
WILLIAM J. FOX, COUNTY ENGINEER BUILDING / -y
I ADDRESS Y
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST yg
ADDRESS /1f� �f z� (')� , CROSS ST. + - IGdd -
LOCALITY �1 � JJ '94-1'94-1-r a DISTRICT 0 SERIAL NO. PERMIT NO.
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CROSS ST. ((
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CITY n 1 1 I�YOA.UTELAO. 7 7 O 0 TRUNK PERMIT NO. n
TATE t �t
REGISTRATION N0. n l v ❑��C.O�UNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
9
`HASTE APPROVAL
SIZE OF LOTN 0 BLD6S. CHARGE
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USE
BUILDINGS CONNECTION CHARGE F
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO ✓
RECEIPT NO .I
PUBLICSEWER @ $ 3.50 DAT BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION-RECORDE
WORK TO HOUSE SEWER 1 00 N0.
ALTER OR REPAIR EXISTING DATE B
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.F� e � Q DEPTH
CESSPOOL—DRYWELL -
SPECIAL CONDITIONS ONLY 2.00 !r M A N H D L EEFSIEFERENCE
.�_ TYPE OF CONNECTION LENGTH FRO1
.;'' Jd�s 'g M.L.TO P L. .'
OWNERS PERMIT $ I 1 00 —
AUTHORIZATION TOTAL FEE
IOLHAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR TCONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE ' DATE
DWELLING TO THE PUBLIC SEW R
SIGNED THIS� �u._DAY OF_._. R1p '' NEW HOUSE SEWER �� -yy. ft�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT a"6s _. �}.- BUILDING OR WORK
....__�. _.._.._.r__._._
SEPTIC TANK,SEEP.PIT($)
ADDRESS...-.........._....----•.•-•--._...------.._.._....-....._-.._._.:_..._......... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED DISCONNECT
AHD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
ABANDON HOPLUG PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
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URE SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE - =—s- a•- - - ...- T /
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