HomeMy Public PortalAbout6418 LIVIA AVE_Sewer__ &E-6D
8 6 69 9-98
APPLICATION - FOR PERMIT 1
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DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles ADDRESS BUILDING//may �p �J
WM.J. FOX, COUNTY ENGINEER ��+�--r�r-
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY c
FOR APPLICANT TO FILL IN NEAREST
CROSS Sr,
LEGALi
DESCRIPTION LOT NO. A OWNER71 � .._�. �y 7
BLOCK TRACT ' ��� MAIL
,ADDRESS
-7 r
NO. OF BLDGS. t .,
SIZE OF LOT NOW ON LOT l CITY TEL:NO
USE OF
BUILDIN AA DISTRICT NO.. GROUP MAP
J BK PG
CONTRACTOR .��
ADDRESS _ CONNECTION DATA
CI TEL. NO. STATION ti 0 DEPTH
(�'SrATE MANHOLE REFERENCE �U'� p UPPER
REGISTRATI N ❑ COUNTY
NO. DESCRIPTION OF WOR FEE
TYPE OF CONNECTION LENGTH FROM /
HOUSE SEWER CONNECTING TO Y. CURB P L ht L TO P L.
PUBLIC SEWER $ 3.50 ,
HOUSE SEWER CONNECTING TO _
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. ORP
C NO i
WORK TO HOUSE SEWER 1.00 CO IMP NO a� - JOB NO.
'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 t 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL-
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 r CHARGES
OWNER'S � 00
PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE __ 'REIMBURSEMENT FEE
I HAVE'TRACTORTO DATE CONNECT THECTEDABOVEWITH THEDESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS OF 4-19 JM+
19 NEW HOUSE SEWER 9-8'-ST8yC4tAAl
OWNER OR i CONNECT ADDITIONAL
OWNERS AGENT t.� BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY D STATE OF DISCONNECT PLUG AND
C LIFORNIA R THAT 14M THE LEGAL OWNER F THE AB VE A DON HOUSE SEWER
S Rj,6ED ESI NT PROPERTY. KFILL SEPTIC TANKS❑ y �j,d
■NLR/sT EP. PIT(S) ❑ CESSPOOLS
OF PER I EE
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FLBG. INSPECTOR
�0 7 6 3 5 SEP 7 4 4.5 0