HomeMy Public PortalAbout6441 LIVIA AVE_Sewer__ ED
15&E-663 9.89 APPLICATION FOR.. PERMIT _
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles fADDRESS
ILDING
WM.J. FOX, COUNTY ENGINEER .0CASSATT D. GRIFFIN,$UP'T OR BUILDING CALITY e/V A/G_Q� �/`7
NEAREST
FOR APPLICANT TOJZ1 INCROSS sr. w Gd /�L� 7
LEGAL
DESCRIPTION LOT NO. OWNERr�,
BLOCK TRACT �V MAIL
ADDRESS
NO OF BLDGS y �� CITY TE
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS r ti DISTRICT NO. GROUP I /BK PG
V /) T MAP
�^(�
CONTR R 0 � {� N��//J �i'�dl�� /
ADDRES � CONNECTION DATA
C ,e WeSG NOVA- STATION DEPTH
•"% ❑ STATE MANHOLE REFERENCE S O /� U44m
REGISTRATION NO.
� o8 ❑ COUNTYLOWER
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO s TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER Q $ 3.50
-C-f!$B- P L. M.L TO P L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG. OR / PC NO
WORK TO HOUSE SEWER 1 00 CO II4P 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 '
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S 5 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EX 1NG,DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S!;#W �� eft NEW HOUSE SEWER �f
SIGNED THIS DAY OF 19,'✓ LJLLf� —dtbU
OWNER O j CONNECT ADDITIONAL
OWNERS ENT ��'G�/rt/►'V BUILDING OR WORK
,1'.r SEPTIC TANK, SEEP. PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL El DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY A STATE OF DISCONNECT PLUG AND
CALIFORNIA OR T AT 1 A-w
L OWNER F THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESID IAL
,o EP.PI L SEPTIC TANKS❑ /1,_1/J �)r� �w
� EEP.PIT(S) ❑ CESSPOOLS (/ L
SIGNATU
OF P MIT E
WI 1 J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
Co9 0 8 4" OCT 17 4.5 0