HomeMy Public PortalAbout9678 LIVE OAK AVE_Sewer__ S&E•663 3.55 APPLICAT�ON FOR PERMIT
DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depcatrnent of County Engineer
County of Los Angeles ADDRESS
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WM.J. FOX, COUNTY ENGINEER ADDRESSS
® CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY ` a
NEAREST - I
FOR APPLICANT TO ILL IN , CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER �s a2 ,
BLOCK TRACTJ,�r ,/'� ADDRESS
N0. OF BLDGS. T
SIZE OF LOT NOW ON LOT r CITY { TEL. NO.
USE OF
BUILDINGS �• DISTRICT NO. GROJ10—
BK
MAP
PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITYC' TEL. NO.1*4- STATION DEPTH g
❑ STATE MANHOLE REF4�RENCE
REGISTRATION NO. �p ! ❑ COUNTY A LOWER
No. DESCRIPTION OF WORK F FEE
-
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Sv Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER a $ 3,50
HOUSE SEWER CONNECTING TO
_
PRIVATE DISPOSAL SYSTEM 1.00 ___
CONNECT ADDITIONAL BLDG. OR P. C. N0.
WORK TO HOUSE SEWER 1.00 CO. IMP, NO. JOB_NO.
ALTER OR REPAIR EXISTING /:
SEWER OR DISPOSAL SYSTEM 1,00 TRUNK PERMIT NO. ROAD PERMIT NO. d®,f� d
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 _ PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR --
PITS AND/OR.DRAINFIELD 300 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL _
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNERS PERMIT CONNECTION CHARGE FEE
$ 1 00
AUTHORIZATION TOTAL FEE " REIMBURSEMENT FEE
HAVE f2
TRACTORTO DATE TRACTE
ITH THE CR BED EXISTING FDW DWELED LING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER -'
SIGNED THIS _DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTBUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THATCOHAVE READ THIS APPLICATION CESSPOOL El DRYWELL CIAND STATE THAT THE ABOVE IS CORRECT-AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY. REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DES R1BED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ -
`' SEEP. PIT(S) ❑ CESSPOOLS❑
WILLIAM J.FOX,COUNTY ENGINEER V ATION R.A.WOOD, CHIEF PL13G. INSPECTOR
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