HomeMy Public PortalAbout9966, 9968, 9970 LIVE OAK AVE_Sewer__ rle
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DEPARTMENT OF COUNTY ENGIN MM SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING_AND SAFETY PERMIT APPLICATIONN
COUNTY OF LOS AGELES
WILLIAM J. FOX, COUNTY ENGINEER J BUILDING
ADDRESS _ 97 70 <C, �G e
FOR APPLICANT TO FILL IN �j�` LOCALITY 9,� - �t 1
BUILDISSyl g/�/, //et, 1�/ 1/� CROSS STNEAREST. ; ( {�,,
ADDRESS 4� C Ll e ,
LOCALITY zez�)��� DISTRICT N0. SERIAL N0. PERMIT N0. c
NEAREST A //Q J
RE�GEI�V�ED1p^BY Ready for Inspection DATE[SSUED
OWNER �r�. 1/�V�✓1U"(il� e�]
MAIL eS USE ZONE OCCUPANCY �mAf--�
ADDRESS G� � � I ' BK,_ PO
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CITY TEL.NO. � ^ G . /623
CONTRACTOR CO.IMP.NO. /
ADDRESS JOB.N0
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a�Jij .
CITY _16�G TEL.NO. TRUNK PERMIT MO.-
STATE
O-STATE n �/ �
/ Os
REGISTRATION NO3,, a COUNTY ROAD PERMIT N0. S(�2
LEGAL
DESCRIPTION LOT NO. �� STATE ENCROACHMENTPERMIT NO
BLOCK TRACT /' QQ INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLD
NOW ON.LOTG3. ` CHARGES
USE OF
BUILDINGSef/��/,!�/� CONNECTION-CHARGE FEE
NO. DESCRIPTION OF WORK FEE EF EF E�- -
HOUSE SEWER CONNECTING TO REIMBURSEMENT
PUBLIC SEWER_ 0 $ 3.50 L3 J` RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO.
PRIVATE DISPOSAL SYSTEM 1.00 o
CONNECT ADDITIONAL BLDG.OR /EXCEPTION RECORDED
WORK TO HOUSE SEWER - - . 1.00
ALTER OR REPAIR EXISTING �NO' I DATE `I`B'l
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 STATION DEPTH
CESSPOOL—DRYWELL r s
SPECIAL CONDITIONS ONLY 200 ^ / MANHOLE REFERENCE
UPPER -
TYPE OpCVlVftTION LENGTH FROM
OWNERS PERMIT $ I I 00 -Yr CURB -P 6 M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS-DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
f"OL
SIGNED THIS-__.:�t.�__ F_
Y O ..___ l f -19 NEW HOUSE SEWER"
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.. .. _ �/?� BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CATIONAND 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/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE IDE8 RIBED RE NTIALL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS[]
OF PERMITTEE ._ -. _ _ ._ �._ __ ._-------
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