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HomeMy Public PortalAbout6333 LIVIA AVE_Sewer__ 5• &E-683 12.64 D APPLICATION FOR PERMIT' * 8 d E•8 DIVISION OF BUILDINGAND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of LOS Angeles BUILDING s WM.J. FOX, COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN, SUIP'T OF BUILDING ` LOCALITY FOR APPLICANT TO FILL IN NEAREST - CROSS ST. � LEGAL 4.�,� `,f DESCRIPTION LOT N0. OWNER Cff 'Y C..i ho, G BLOCK TRACT . / MAIL q DRESS(LL !�fA Ai/F, - .•- O OF SLOGS. / SIZE OF LOT / NOW ON LOT CIT GF TEL. NO USE OF BUILDINGS QL DIST NO. I GROUP- I MAP B CONTRACTOR "� i itP G � v ADDRESS CONNECTION DATA CITY (�.e. TEL. NO. d.® � STATION / '� i ® DEPTH �a ❑ STATE ���,vq REGISTRATION NO , 6q1 El COUNTY _ O �O.) M UPPER ERENCE LOWER —y TYPE OF CONNECT LENGTH FROM No. DESCRIPTION OF WORK FEE Y. CURB /fes PL. M L.TO P.L. SEWER CONNECTING TO PUBLIC 5/p PUBLIC SEWER Q $ 3 50 jJ "� HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG. OR are CO. IMP. NO. �® JOB NO WORK TO HOUSE SEWER 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 DIS-OSAL SYSTEM 100 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 S 1 00 AUTHORIZATION .TOTAL FEE1 . REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INS OR'S SIGNATURE TO THE PUBLIC Sq4m SIGNED THIS DAY OF t vtP^I 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL O OWNERS A EN UILDING OR WORK TIC TANK, SEEP, PIT(S) ADDRESS ND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL CATION CESSPOOL[IDRYWELL❑ - AND 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 LI4 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG SYSTEM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR:THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEWOPERTY. O BACKFILL SEPTIC TANKS❑ , SEEP. PIT(S) ❑ CESSPOOLS I'U w , '1 .• SIGNATURE OF PERMITTEE M/ILLIAM J. FCX. COUNTY ENGINEER VALIDATION By Ip 'C6 9,,P_ 3 7u OCT 21 4 5.5 n In DEPUTY DEPUTY BY BY ,'© DEPUTY AWPUTY