HomeMy Public PortalAbout6452 LIVIA AVE_Sewer__ 76A66YD
S 6-863 3-55 APPLICATION FOR PERMIT
8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDIN-ADDRESS G y. .si I WM.J. FOC. COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY �/� � �� T
FOR APPLICANT T FILL IN cRoss s. J �' fr d JC'i
LEGAL / /
DESCRIPTION LOT NO. 40 OWNER
BLOCK TRACT 2 -:5—AV MAIL �,y
ADDRESS /1C
NO. OF BLDGS.
SIZE NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICT NO. GROUP MAPBK
P11+ /
ADDRESS , ® ;cy, - -G.� CONNECTION DATA
--
NO. � �'� STATION DEPTH �f
❑ STATE MANHOLE REFERENCE P UPPER
REGISTRATION N0. / �sfj'! Cal/ ❑ COUNTY �I � J '�OWr=R
NO DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM IgE
HOUSE SEWER CONNECTING TO �.--n ,yam= lctrgst, P L M L TO P L. '3
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 _
CONNECTNO
WORKTO HOUSE ADDITIONAL N
EWERLDG. OR 100 CO IMP NO ,� P JOBB 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 100 PERMIT NO
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYW ELL
WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
OWNER'S PERMITCONNECTION CHARGE FEC
$ 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE app�y
I HAVE THIS DATE CONTRACTED WITH THE HEREIN AMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EX157 WELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SE
r
SIGNED THI DAY OF NEW HOUSE SEWER
OWNERO �� CONNECT ADDITIONAL
OWNERS 0. N L ���G�• BUILDING OR WORK
�q SEPTIC TANK,SEEP, PIT(S)
ADDRESS.�� y� / 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 LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR AT 1 AM THE LEGAL-O�1/NER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RES TIAL PERT ' BACKFILL SEPTIC TANKS❑
Tr
G SEEP. PIT(S) [ICESSPOOLS
SIGNATURE -
C6 E /
lbJ.FOX.COUNTY ENGI EER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
AGO 9 0 8 0 OCT 17 4 4 .5 0 In
. e/