HomeMy Public PortalAbout6327 LIVIA AVE_Sewer__ 76A642D _ APPLICATION FOR PERMIT���� 1
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DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles A DRESSG !O
WM. J. FOX. COUNTY ENGINEER
CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEG
DES RIPTION LOT NO. !�
OWNER �� �j f FFF�����,
BLOCK TRACT 4� AMA IDDRESSA ; Z 7 !`
NO. OF BLDGS. 4 '
SIZE OF LOT NOW ON LOT CITY Erwo
"�
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
c BK PG
CONTRACTOR I ��� J
ADDRESS - CONNECTION DATA -
CITY TEL. N0. 4 7 A4.. STATION 015�O DEPTH
1 •' ❑ STATE � - MANHOLE REFERENCE
REGISTRATION NO. ❑ COUNTY a UPPER LOWER
TTTT TYPE OF CONNECYG�� LENGTH FROM ��`
NO. DESCRIPTION OF WORK FEE Y CURB P L 7 M L.TO P L.
HOUSE SEWER CONNECTING TO
A
PUBLIC SEWER Q $ 3 50 I`I Fd
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO. IMP. NO. /tJ / JOB. NO.
AL WORK TO I1CrrP;E SEWER7— 1 00 /
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD 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
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE TOS CONNECT DATE CO
ONECTONTRTHEA ABODVEWDESCR BED EXISITH THE NINGAMED DWELLIING APPROV`FALS DATE INSPECTOR SSIGNATURE
TO THE PUBLIC SEWER cc NEW HOUSE SEWER 17
SIGNED THIS _ —DAY OF
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI TION CESSPOOL❑ DRYWELL[IAND 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
IHEREBY CERTIFY THAT I AM PRO 19RLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE-tLG-L {WNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERT �' BACKFILLSEPTIC TANKS[I SEEP. PIT(S) ❑ CESSPOOLS .3' I-S
SIGNATURE Vii.
OF PERM ITTEE.--'"�
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
r 11,0 Y 4 4 7� JUL 8 4 5-50
In
BY
DEPUTY DEPUTY
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BY
BY
® DEPUTY DEPUTY