HomeMy Public PortalAbout6427 LIVIA AVE_Sewer__ 24650 INSERTS
' CES08 a-80 -
7 6A 8 42 D APPLICATION FOR PERMIT
,
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING l
ggr�aa ADDRESS � /
WIIIIAM AIOHN A. ENSENCSup of Building
LOCALITY
rRy"4 RMT TRI NEAREST FOR APPLICANT TO FIU IN CROSS ST.
LEGAL
DESCRIPTION LOT NO OWNER,
BLOCK TRACT MAIL -
z J D ADDRESS
NO OF BLD S.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDDI DISTRICT NGROUP MAP PROCES D NGS - O. BY '
BK PG
CONTRACTORUL
ADDRESSCONNECTI N DATA -
CITY TEL.NO. 4! 6 - ,STATION 3� DEPTH
STATE MANHOLE REFERENCEIfUPPE
' REGISTRATION NO V COUNTY /7.
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Co) $3 00 TYPE OF CONNECTIO LENGTH FROM
PETS AND/OR DRAINFPTIC TANK, GELDIT OR @ $3 00 Y. CURB .L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO. JOB N0. W
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @ $1 00
SEWER OR AIRDIISPOSAL SYSTEM HOUSE @ $1 OO STATE ENCROACHMENT pq
PERMIT NO
INDUSTRIAL - -
.WASTE APPROVAL _ W
" CHARGES L
OWNERS PERMIT 2 00 CONNECTION CHARGE FEE �(
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. :;/
SIGNED THIS " DDA OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK -
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ABANDON CTPLUGAHOUSE D -
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESID IAL PROPERTY. BACKFILL SEPTIC TANKS ❑ p—/ / <��
SIGNATURE li SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITTE
®r
VALIDATION--, ROBERT A. WOOD
CK. M.0, CASH SUPERVISING MECHANICAL,ENGINEER
9 0 5 ;:nit 14 D 5.0 0 ��
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
ANEAREST
DDREISS NG I A k ik'1'4 CROSS ST. C-,
LOCALITY DISTRICT NO SERIAL NO. PERMIT NO. C
NEAREST �, / � r�;�� A 1176--117 J
CROSS ST. y.® RECEIVED BY Ready for Inspection DATE ISSUED_
OWNER AnA_ v a max e 5-6 _3
MAIL
-ADDRESS.- USE ZONE OCCUPANCY BK MAP PG
CITY i�, TELNO. / I+
CONTRACTOR M. C. Noitirlgham Co. of Temple City CO.IMP.NO.
5933 N. CLOVERLY AVE.
ADDRESS JOB.N0.
CITY TELAO. TRUNK PERMIT NO.
f 7W B STATE
REGISTRATION NO. / COUNTY ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT WASTE APPROVAL
SIZE OF LOT NO.OF BLDG&
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' DATE 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 DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 '�® MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT s I 1 Y' CURB P.L. M.L.TO P L.
AUTHORIZATION I TOTAL FEE I a
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 /,,��--�
SIGNED THIS._.-.._. .DAY OF-.._.._.___ �.-�_19�. NEW HOUSE SEWER P Yef ��- a,,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........._......_...... BUILDING OR WORK
ADDRESS...............-......_.-...-----------—.------._...----•----_..—._.._.._. SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD �q
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSP06 I�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
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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
�p /� p� q!/��Il�A /►/� SEEP.PIT(S)[] CESSPOOLS
OF PERMIT TEE{ ,.JCr-_N0T.Tj NJif--LjW--LVr--------.._.._...
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