HomeMy Public PortalAbout9917 LIVE OAK AVE_Sewer__ b 6.883 APPLICAT'IONV FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer # E
County of Los Angeles BUILDINGADDRESSWIA J. FOX, COUNTY ENGINEER 7�ACA98ATT D.GRIFFIN,SUPT OF BUILDING LOCALITY �FOR APPLICAry
NT `TO FILL IN CROSS ST AlLEGAL /DESCRIPTION LOT NO ♦ OWNER iiBLOCK TRACT MAIL
ADDRESS
NO. OF BLDGSSIZE OF LOT NOW ON LOT CITY
USE OF
BUILDINGS DISTRICT N0. GROUP tdAP
PG
CONTRACTOR
ADDRESS °TIN T�ORDICA -CONNECTION DATA
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CITY ARCADIA, CA¢,jtV RTTTA STATION /1 DEPTH
❑ STATE MANHOLE REFERENCE
REGISTRATION N0. ❑ COUNTY `�-L+ �YJ� � L LOWER
NO DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM 3
Y
HOUSE SEWER CONNECTING TO CURB P L. M L TO P L.
PUBLIC SEWER Q $ 3 50 4 .y
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 -
CONNECT ADDITIONAL BLDG. OR P C NO
WORK TO HOUSE SEWER 1 00 CO IMP. NO. Q JOB NO `
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO FFFJJJ ROAD PERMIT NO 2 0'
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-DRYW ELL
WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
$ 1 00
OWNER'S PERMIT CONNECTION CHARGE FEE
J
AUTHORIZATION TOTAL FEE G REIMBURSEMENT FEE
I HAVE DATETRACTORTTOS CONNECTO THE ABOVE DESCRIBED EXISTINGWITH THE HEREINA DWELLING APPROVALS DATE INSP CTOR'SSIGNATURE
TO THE PUBLIC S E
epi atj NEW HOUSE SEWER
SIGNED THIS -DAY OF '��+" -- 19 AOWNER
..ttss jj s r y�,� �`¢y" .f .� CONNECT ADDITIONAL
OR
OWNERS AGENT��0.-Q"Qj �w l� B�'3 � '$ek. q`' BUILDING OR WORK !
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL ElAND 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 -
I 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
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
a SEEP PITS) ❑ CESSPOOLS❑
SIGNATURE - Ya"a `., .
OF PERMITTEE Xov - - -
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
r LAj0 4 6 6 0-LI A31 4 4.5`0 m
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