HomeMy Public PortalAbout6449 LIVIA AVE_Sewer__ D
6&E-669 3.56 APPLICATION FOR PERMIT _
8 6 E-8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County EngineerBUILDING
County of LOS Angeles ADDRESS Gl�F ! �/S 6✓ �/
WM.J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY /% �9c. '71
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FOR APPLICANTAO FILL IN NEAREST
A . !D a L 4,
DESCRIPTION LOT NO. rV OWNER �i VV
BLOCK TRACT t M ADD
AIL RESSRESS �
` c
NO OF BLDG/
SIZE OF LOT NOW ON LOr CITY TEL NO.
BUILDINGS DINOF GS ^ DISTRICT NO. I GROUP MAP
COIdT�CTQR f ' �+,.
ADDRES � o `pi( /jI L�;s-' CONNECTION DATA
41
TEL. NO& '7�• STATION DEPTH 0
y� JD ❑ STATE MANHOLE REFERENCE '� UPPER
REGISTRATION NO. r_�/`/ ❑ COUNTY LOUR
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO r TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER Q $ 3 50 + T� P L M L TO P L F.»
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 _
CONNECT ADDITIONAL BLDG. OR ,} P C NO
WORK TO HOUSE SEWER 1 00 CO IMP . ,Y 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
CONNECTION CHARGE FEE
OWNER'S PERMIT s � 00
AUTHORIZATION 1, TOTAL FEE . '� REIMBURSEMENT FEE
TRACTORHAVE TTOS DATE CONNECT THE ABODVEWITH THE DESCR DESCRIBED EKISTINGAMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SE E
SIGNED THIS _ DAY O�4r/� � NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL r
OWNERS .0GEN BUILDING OR WORK
ADDRES' �/r� �t SEPTIC TANK. SEEP, PITS)
" r' AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANG UNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I A THE L WNER OF THE ABOV ABANDON HOUSE SEWER
DESCRIBED E IAL P RT SEEP. PIT(S) [ICESSPOOLSI ' lV CRS
BACKFILL SEPTIC TANKS('.,
SI
F P iT
I 1AM J.FOX.COUNTY EN (NEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
Co 9 0 8 5-, OCT 17 4 4.5 0 In