HomeMy Public PortalAbout9712 LIVE OAK AVE_Sewer__ I Qq_®.yp� py�g� ypa�. 7 \
76AC420 APPLICATION,-ION, FOR PERMIT 1
S&E•663 12.54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Loa Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY i (diQ
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DE CRIIPTIONLOT NO. /V I �-/ -�}2 �-�i y 0/11 OWNER4413 /
BLOCK //�-TRACTMAIL'�Cw�(/s11s- ADDRESS �(���r.`
/// NO. OF BLDGS, �J r
SIZE OF LOT tV S 0 NOW ON LOT 7 CITY a'�. TEL. NOUSE OF
BUILDINGS DISTRICT NO. I GROUP I BK K MAP
PG
CONTRACTOR
IJ '7
ADDRESS / �/. c.8. CONNECTION DATA
CITY TEL. NO. ® //,Ve 3 �'� STATION DEPTH
i, ❑-STATE MANHOLE REFERENCE
REGISTRATION NO. �1?237 ❑ COUNTY UPPER LOWER
TYPE OF CO ECTION LENGTH FROM
NO. , DESCRIPTION OF WORK FEE Y CURB P L. M L TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. JOB N0.
WORK TO HOUSE SEWER 1 00 _� Q
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. AD 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 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 + CHARGES
CONNECTlO HARGE FEE
OvRMIS PEST 8 1 00
AUTHORIZATION TOTAL FEE � GO REIMBURSEMENT FEE � � Leh'
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF Y-1 ��1y— NEW HOUSE SEWER A
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT � BUILDING OR WORKGXI.r-
�27 O �E� .5� - SEPTIC TANK, SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL❑
AND 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT-IAM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE +� -
WILLIAM J. FOX, COUNTY ENGINEER
VALIDATION ADD C
BY _,WAD Y �n7 R 2 J 2,0 O
DEPUTY - DEPUTY ,
.BY BY vim/
® DEPUTY_ _ _ DEPUTY