HomeMy Public PortalAbout9706 LIVE OAK AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DliPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES _
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS .
FOR APPLICANTTO ILL I LOCALITY
BUILDING /—
ADDRESS KJ., L CROSSNEARST
CROSS ST.
LOCALITY
DISTRICT N0.` SERIAL NO. PERMIT NO.
NEAREST A e �C f C
CROSS ST. ellRECEIVED BY Ready for Inspection �` DA-VE ISSUED
OWNER•,, e145 Ar
MAIL /o��+lQ USE ZONE OCCUPANCY
; ADDRESS K PG
CITY - TEL.NO. 10' . . ^ I
s
CONTRACTORj�
�j. CO.IMP.N0. F�
'a ADDRESS �—+ JOB.NO.
CITY ✓��/�/►� '\TEL.NO. � TRUNK PERMIT NO.
® STATE _
REGISTRATION NO. 0 NTY' ROAD PERMIT NO.LEGL
DESCRaPTION LOT N0. / / /f STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT INDUSTRIAL
NO.OF WASTE APPROVAL
SIZE OF LOT$$ NOW ON LOTS \' CHARGES
USE OF
CONNECTION CHARGE FEE
-• r BUILDDINGS �
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 ��, RECEIPT NO. J DATE JOY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO
ALTER OR REPAIR EXISTING DATE I BY,--,\
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT ARID ABANDON SEWER -
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
EPTIC TANK,SEEPAGE PIT OR / �
PITS AND/OR DRAINFtELD 2.00 STATION • DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 p` i MZHOOL R EFERENCE � ' LG-11 EiiI�
Nrs 9YPPE=ft TION LENGTH FROM
OWNERS PERMIT $ I 00 �CURe 5_P__'L;, M.L.TO P.L.
;u AUTHORIZATION I' TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED '
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR' SIGNATURE DATE
DWELLING TO THET)J BLIC SEWER
7___.... _^ 19� NEW HOUSE SEWER •o�
- SIGNkED THIS-_.._..__. __DAY OF.... _.. _._ __ _ , •
OWNER_ OR CONNECT ADDITIONAL
7. BUILDING OR WORK
OWNERS AGENT-=-
zJt?� TIC TANK,SEEP.PIT(S)
ADDRESS'.__._. .___
CD/OR DRAINFIELD
1 HEREBY AC NOWLEDGE THAT 1 HAVER AD THIS APPLI. SPOOL❑ DRYWELL 0
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
„ AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUG
i/
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN
ER OF THE ABO SCRIBED RESIPE"AL PROPERTY. BACKFILL SEPTIC TANKS
E
SIGNATURE Q/vf SEEP.PIT(S)� CESSPOOLS ��,, iW
OF PERMITTEE `•-'•:.
76AG42A 663 7/53