HomeMy Public PortalAbout10618 LIVE OAK AVE_Sewer__ r DEPARTIKENT OF COUNTY ENGrNEER , SEWER-SEWAGE DISPOSAL
-DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS Q�p' Live Ocol
FOR APPLICANT TO FILL"IN LOCALITY �
ADDRESS , to7 j 16 _ CROSS ST. ,r-m. k I V i
LOCALITY ���„�. its. DISTRICT NO A SERIAL NO. q�PERMMIT NO.
NEARESTA c
. %L. n_ {� U 1
CROSS STJ
'K.��' R1lECEIVEDBY Ready forinspection DAT SSUED
OWNER v JGCOlp
MAIL c
(, USE 20NEY OCCUPANCY MAP
ADDRESS O BK PG
CITY , TEL.NO. V� ^L A-1
CONTRACTOR CO.IMP.NO. 14
ADDRESS J JOB.NO.
CITY jVt, TEL.NO. G�7 O(D� TRUNK PERMIT NO.STATE
REGISTRATION NO.
,� to 8 COUNTY ROAD'PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. q�'��_ Cyc PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF BLOTS.
J�D -NOW 3 CHARGES ON LOT J
USE OF nn Dyke CONNECTION RGE FEE
BUILDINGS X•�/✓ti""�� H�
y
NO. DESCRIPTION tIF WOR FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO J
PUBLIC SEWER @ $ 3.80 3sv 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 0 O `
NO.
ALTER OR REPAIR EXISTING I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND AND/OR DISPOSAL SYSTEMN SEWER 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAE
PITS AND/OR DRAINFGE DIT OR 2.00 STATION g 1 DEPTH 2
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00O MANtIHO�EEE__R�EFERENCE LOWE
TYPE OF CONNECTION_ LENGTH FROM
"ll!- � ��P L� M.L.TO P.L. A9
OWNERS PERMIT 3o0 I
AUTHORIZATION TOTAL FEE 5,6
[CDE
VE THIS DATE CONTRACTED WITH THE HEREI NAMED
RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
LLING TO THE PUBLIC SEWER _
ED THIS.-.._. DAY F-. _ _ 19 NEW HOUSE SEWERJi-
ER OR CONNECT ADDITIONAL
ERS A EN BUILDING OR WORK
- - �
SEPTIC TANK,SEEP.PIT(S)
ESS ......... ..----...__. _ _.. _. L._.._._.. AND/OR DRAINFIELD
EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
ON AND STATE THAT THE ABOVE IS CORRECT AND AGREE
MPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR.SEWER OR
LATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTEREDDISCONNECT PLUG AND
OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
F THE ABOV DESCRIBED RESIDENT AL ROPERTY. BACKFILL SEPTIC TANKS 0A
SEEP.PIT(S)❑ CESSPOOLSATUREERMITTEE - - 'C .................................
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