HomeMy Public PortalAbout6460 LIVIA AVE_Sewer__ ®® g�� � ® PERMIT®�/� °'gam
5&E-6D APPLICATION FOR PERMI1 1
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DIVISION OF BUILDING AND SAFETY SEWER SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILD �
WM.J. FOX, COUNTY ENGINEER ADDRE
Q CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY Ieyf 1-4-c
FOR APPLICANT TO FILL IN NR AREST
S STWNER e-
LEGAL A
DESCRIPTION LOT N0. ! �f
BLOCK TRACT MAIL
ADDRESS
NO. OF BLDGS.
SIZE O NOW ON LOT CITY TEL NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
6�//t.7 •B�Larl BK PG
CONTR 0 G
ADD S _ lY'^ZE' l/ G. CONNECTION DATA
C
TEL NSOgZ�C , STATION DEPTH
Pr
�J ❑ STATE MANHOLE REFERENCE fi °
REGISTRATION NO. /l� ❑ COUNTY LOWER
N DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER Q $ 3 50 S r Ysr` Gkma- P L M.L TO P L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ' 100
CONNECT
WORKTO HOUSESEWER BLDG. OR 1 00 CO IMP NO. JOB NO
ALTER OR REPPIR 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 DRAINrIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
$ � 00
OWNER'S
PERMIT CONNECTION CHARGE FEE
y�
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN AMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBEpgrEXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC
SIGNED THI f DAY Q10��.v�/ I�� NEW HOUSE SEWER
OWNER OR 'CONNECT ADDITIONAL
OWNERS AGE / BUILDING OR WORK
i SEPTIC TANK, SEEP, PIT(S)
ADDR
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL[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 -
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR -
LICENSED AS REQUIRED BY LOS ANGELES COUyND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR 1 M TH GAL O*N F THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RE D A ROP
BACKFILL SEPTIC TANKS❑
SIGNATU G n
v SEEP.. PIT(S) ❑ CESSPOOLS � Ij
OF MI E '' _ J ,
WIlr=L1A J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
eco 9 0 0 7 r OCT!7 4 4.5 �,