HomeMy Public PortalAbout9838 LIVE OAK AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER I. SE�IEIt-SE�/AGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES I ^
WILLIAM J. FOX, COUNTY ENGINEER BUILDING// 1 p� �' C ���,
I ADD % �J Cl L� ' .f�yt�P 0'�'�
FOR APPLICANT TO FILL IN ; LOCALITY
BUILDING �+fP�� ��/ ��J 6{� �� ✓
ADDRESS OO �-/ CROSSST.
LOCALITY /��,) .f�� y `DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST v � VZ
CROSS ST.
IRECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
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ADDRESS
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CITY
O-CITY TELAO.
CONTRACTOR CO.IMP.NO.
ADDRESS J�O• �AX �77 JOB.NO.
CITY Vi TELAOTRUNK PERMIT NO. `�-
REGISTRATION NO. Q Q� COUNTYpu
ROAD PERMIT N0.
LEGAL ���1� gTATE ENCROACHMENT
DESCRIPTION LOT N0. G PERMIT NO.
BLOCK ( TRACT /�*/ WpSTSE APPROVAL �' `---
SIZE OF LOT �^ J 1
NO.OF BLDGS.
�✓ O NOW ON LOT ® CHARGES N
USE OF '� r � �'• 'r'--' a.
BUILDINGS ��' /�,�yJe�� CONNECTION CHARGE FEE
a 3
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 L RECEIPT NO. DATE BY
(-,r%1 /J
HOUSE SEWER CONNECTING TO Woe, vi
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDO.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING _ I I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 ��-- --
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM = `1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 _ STA 10 r� DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER — i2sWeR
TYPE OF CONNECTION LENGTH FROM '
36
OWNERS PERMIT s I I pp �• l�_.P. k� M L.TO PU.G d
AUTHORIZATION TOTAL FEE I L 5.6IHAVE X/ T_? �/b
CONTRACTOIS DATE R TO CONNECT THE ABOVE DESCRIBEDED WITH THE EXISTING ED A PROV�ALS INSPECTOR' SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER�},- / - r r
SIGNED THIS---�-'__------DAY OF._,gip. __..-._......._191! NEW HOUSE SEWER 1� Co zQ;{f �_ �,S 43
OWNER OR CONNECT ADDITIONAL
��_..__. BUILDING OR WORK
OWNERS AGENT
- SEPTIC TANK,SEEP.PIT(8)
ADDRESS......................... - -....---------------------------- AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS-ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE,LEGAL•OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. : BACKFILL SEPTIC TANKS
a SEEP.PIT(S)[:] CESSPOOLS❑
SIGNATURES , �`y �
OF PERMITTE - - .............. ...--....:____..:.'_. ... -
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