HomeMy Public PortalAbout9972, 9974, 9976 LIVE OAK AVE_Sewer__ DEPAIViV ENT OF COUNTY ENGINEER, SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY L PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENDINEER ADDRE S i+,�� w�
ADDRESS CEJ (J
FOR APPLICANT TO FI L IN LOCALITY -7-ejnn ,/ C/A
BUILDINSNEAREST
ADORE
CROSS ST.
LOCALITII DISTRICT NO. SERIAL NO. PERMIT NO..
NEAREST A JZg 50�
3 ` S
CROSS ST.
RECEIVED BY Ready for Inspection DATE I/SSUED
OWNER
MAIL USE ZONE/ OCCUPANCY MAP
ADDRESS I BK PG
CITY o- � `TEL.NO.
CONTRACTOR - CO.IMP.NO. �-
ADDRESS
J 0 B NO. r^---�
CITY TEL.NO. ellTRUNK PERMIT N0.
STATE
REGISTRATION NO. e Q COUNTY ROAD PERMIT NO. �290 C�
LEGAL
DESCRIPTION LOT NO. ` STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT `���� INDUSTRIAL
WASTE APPROVAL �—
SIZE OF LOT NO.BF BLOTS.
NOW ON LOT CHARGES
USE OF ����
BUILDINGS �,// C� CONNECTION. HARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEW ER (d! f 3.50 RECEIPT N0. I �DpT\ I BY
HOUSE SEWER CONNECTING TO /
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.ORXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- 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 DRAINFtELD 2.00 STATION `f DEPTH 7
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00D�`�/l ANHO ER REFERENCE —LOW-ER-
TYPE OF CONNECTION LENGTH FROM ^ l
OWNERS PERMIT $ 1 00 Y. - CURB 1/ P.L. M.L.TO P.L. L
AUTHORIZATION TOTAL FEE 5Ti
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
E P R
t ')
SIGNED THIS----f---------DAY OF.i� -•-----------__....I NEW HOUSE SEWER r / \ ,
OWNER OR v CONNECT ADDITIONAL
OWNERS AGENT. ___ __ . . ....................... BUILDING OR WORK
ADDRESS......... _ _ SEPTIC TANK,SEEP.PIT(S)
- AND/OR GRAINFIELD
1 HEREBY ACK OWLEDGE THAT I HAVE AD THIS APPLI-I CESSPOOL 0 DRYWELL E
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESEWERAND STATE OF CALIFORNIA OR THAT I AM THE LEG OWN-
ER OF THE ABO4SCRIBEDJIESIDE IAL PROP BACKFILL SEPTIC TANKS El
SIGNATURE SEEP.PIT(S)� CESSPOOLS
OF PERMITTE .. lc_-
76A642D 663 1/53