HomeMy Public PortalAbout10278 LIVE OAK AVE_Sewer__ DEPAWfAriENT OF COUNTY ENGINEER f SEWER—SEWAGE DISPOSALDIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENQINEER I ADDRESS
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FOR APPLICANT TO FILL-IN LOCALITY
BUILDING � ��� NEAREST
ADDRESS I �j , v /� Af CROSS ST.
LOCALITY —�-j DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST 5 A 2Z��J r J
CROSS ST. ECEIVED BY Ready for Inspection DATE ISSUED
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OWNER Qu USE ZUKC�_ A
MAIL OCCUPANCY � MP�JT
ADDRESS 1 Oat I BK PG
CITY O TELAO. I R ►1
CONTRACTOR CO.IMP.NO. --
ADDRESS JOB NO.
CITY TEL.NO.Q ❑❑ TRUNK PERMIT NO.
REGISTRATION NO. �1 �.ES0 NT
Y ROAD PERMIT NO. -�
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. -0�\N St) m
PERMIT N0.
BLOCK 2� TRACT F +- ns p `S I INDUSTRIAL `-
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
x NOW ON LOT CHARGES
USEOF
BUI DINGS \ v 11� CONNECTIO ARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ = 3.50 �� RECEIPT NO. E BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD®.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 'Z DEPTH 'S
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 1 MAN OLE REFERENCE
LO W
TYPE OF CONNECTION—,,_, LENGTH FROM
OWNERS PERMIT ; 1 00 P L. l L TO P.L. t
AUTHORIZATION I TOTAL FEE '�6-0
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..--)--4____DAY OF--- ------------- 19;^ NEW HOUSE SEWER S bG 3 - 4—
OWNER OR ///�//�� � CONNECT ADDITIONAL
OWNERS AGENT.._"_!�_:!:_�C--'-- r�� °-.�T BUILDING OR WORK
p /y SEPTIC TANK.SEEP.PIT(S)
ADDRESS _.--� _ _t_.___--. 0 CCS—} .__ � AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-t CESSPOOL[-] DRYWELL E]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
1 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
SEEP.PIT(S)11 CESSPOOLS
SIGNATURE T
OF PERMITTE ._ F _-_----------__T. -'-
76A642A 663 7.4