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HomeMy Public PortalAbout10526 LIVE OAK AVE_Sewer__ D 8a E-689 9-SS APPLICATION , FOR PERMIT 8 @ E•8 DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Depcatment of County Engineer r�' .�•� County of LOS Angeles BUILDING ` .� I +dr WM.J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY LEGAL FOR APPLICANT TO FILL IN NEAREST / CROSS ST. DESCRIPTION LOT NO.[pppiggqqr t9/1` 40f 32, OWNER l BLOCK TRACT (.� AI L p DRESS/DLJ/ �'NOOF BLDGS.SIZE OF LOT jS NOW ONLOT � CITY r TE USE OF BUINGS " DISTRICT 140. GROUP I MAP CONTRACTOR ADDRESS J CONNECTION DATA CI TEL. N j STATION DEPTH •�v G: AF/• ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION N0. ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE - + T w1- '9�� TYPE OF CO NECTION LENGTH FROA7 HOUSE SEWER CONNECTING TO Y. CURB P L. M.L TO P L. PUBLIC SEWER Q $ 3 50 ., HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 _ CONNECT ADDITIONAL BLDG. OR qq .q P C NO WORK TO HOUSE SEWER 1 00 L! ll CO IMP NO JOB NO ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES -i E- CONNECTION CHARGE FEE OWNERS b 1 00 AUTHORIZATION I TOTAL FEE ©C) REIIA13URSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS —DAY OF 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[3DRYWELL❑ - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMP+.Y - 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 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP. PIT(S) CESSPOOLS[] SIGNATURE OF PERMITTEE _ f WILLIAM J. FOX. COUNTY ENG E AIMATION R.A.WOOD, CHIEF PLBG. INSPECTOR 1 7 7 u M':l+ 154 4.00 r