HomeMy Public PortalAbout9208 LIVE OAK AVE_Sewer__ C� �% I J HDEPAIVJrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
13,E W DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES p L /
WILLIAM J. FOX, COUNTY ENGDDINEER ! AEISS 92 0,5Z I—Iy'e o::7/< Aye,
BMWs
FOR APPpL�ICANT TO FILL IN LOCALITY T�1DA &A-1BUILDING
NE ST
ADDRESS �YU d Com/Ute' �� � ��f CROSS ST. /T cj °7 !eS SrLv4a°/J
LOCALITY !� Cl DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST �r // 5- 2,287 2-
CROSS ST.�G yfC/iJ// S d /(J h-JiYTC/ A S
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER G /z-/,' ,/,,
MAIL
ADDRESS USEZONE OCCUPANCY MAP
BK PG
CITY TEL.NO. �— G
CONTRACTOR CO.IMP.NO. 131 --1 D
ADDRESS�- �V 3 C. 3 Z �% j �`
� JOB N0.
�O:
CITY s- ����-, TE —=� 7 2.
`/ / TRUNK PERMIT Po0.
REGISTRAT QUI N0. V 7 f� exp COUNTY ROAD PERMIT N0. 3 /STATE p ! ?!
LEGAL 9 STATE ENCROACHMENT
DESCRIPTION LOT Po0. / PERMIT NO.
BLOCK TRACT 7 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT !�lC�Q NO.OF BLDGS. /
NOW ON LOT CHARGES
USE OF �•
_BUILDINGS // /-/' CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE lll,
HOUSE SEWER CONNECTING TO l_ REIMBURSEMENT FEE
PUB_L_ICSEWER Lal $ 3.50 3 JD n RECEIPT NO. I DATE I 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 NO. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /7125, 5
L-•� /
PITS AND/OR DRAINFIELD 2.00 STATION !TL�, DEPTH (r9
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFEER� NCF�
UPPER ��f .� ,�. DP LOWER
TYPE OF CONNECTION LENGTH FROM '/?.!
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L. H 7
AUTHORIZATION ( TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT-THE ABOVE DESCRIBED EXISTING
DWELLING TO THE/PU•BtIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
7.
SIGNED THIS DAY OF
< ----•--- � I'4...-•--• F rr'L�
v J a � , NEW HOUSE SEWER �/ �f
�2 -
-
OWNER OR '`' CONNECT ADDITIONAL
"�/l"�� •P-L L-t- �' `L BUILDING OR WORK
OWNERS AGENT ---- --- - %,
_ .
ADDRESS �.Y� f. a-. i - SEPTIC TANK,SEEP.PIT(S)
- ` -- - -...--•----.........••.... AND/OR DRAINFIELD
w
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL '
CATION AND STATE THAT Tj�IiIE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL C LINTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMB! AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY P
yEGISTERED DISCONNECT PLUG AND
AND/OR LICENSED-(AS REQUIRED BY LOS ANG S,COUNTY
AND STATE OF CA. RNIA OR THAT I AM TH LEQ`AL OWNS ABANDON HOUSE SEWER_
ER OF THE ABOVE DESCRI ED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE (J SEEP.PIT(S)Ej CESSPOOLS E
PR OF PERM ITTEE:=-= ... ----`-------- - '` -----------
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