HomeMy Public PortalAbout6433 LIVIA AVE_Sewer__ X 8 E•883 3-88 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL,
Dep. ent of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS O[/,
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL t
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
NO. OF IfLDGS.
SIZE OF LOT N W ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
_ BK PG
CONTRACTOR �- 157 ,r. ar— —
ADDRESS CONNECTION DATA
CITY _7,9L. N . 'STATION Y DEPTH
STATE MANHOLE REFERENCE 41//•.y A
,Fbe
REGISTRATION O. / ❑ COUNTY ��f LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION ENGTH FROM
HOUSE SEWER CONNECTING TO J1 Y CURB P L M L TO P L.
PUBLIC SEWER Q $ 3 50 !/
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 _
CONNECT ADDITIONAL BLDG. OR / P C NO
WORK TO HOUSE SEWER 1 00 CO. IMP NO - �/ 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 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR i
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
� � o0
OWNER'S
PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE TRACTOR?TO CONNECT DATE THE AABOVE CTED WDESCR BED EXITH THE ISTING-DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWR
SIGNED THIS D OF � � NEW HOUSE SEWER 9. •�sJ , �L
WNER OR p CONNECT ADDITIONAL 66 7l
OWNERS AGENT QW�7W/� BUILDING OR WORK
ADDRESS �s�3 3 �.[�/`�c-r.� u•�Y/'t' SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
I0ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OW ER OF HE (ABOVE ABANDON HOUSE SEWER.
ESCRIBED DE PROPTY �� BACKFILL SEPTIC TANKS C
SEEP. PIT(S) CESSPOOLS S
SiG�NATUR O�
T [:1OF PERMITTEE .
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF FLBG. INSPECTOR
_-AC06 8 9 9�j AUG 19 4 4.5 D in
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