HomeMy Public PortalAbout6467 LIVIA AVE_Sewer__ S&E-6D APPLICATION
P ICATION 0 OY • PERMIT
5 8 E-863 3.85 II^^99 EE 7 fs
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE ®1 S POSH L.
Department f of County Angeles
Engineer
County of Los Angeles TADDRESS
ING
WM.J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING ITY
FOR APPLICANT TO FILL IN ST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER V,
BLOCK TRACT MAIL
ADDRESS
NO OF BLD
r.
SIZE OF LOT NOW ON L CITY L,
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
CONT OR e
ADD '- �G./ {� , CONNEECCTTIION DATA g
CIT !_ 3 STATION DEPTH
❑ STATE MANHOLE REFERENCE v UPPER
REGISTRATION NO ❑ COUNTY 01
No 0 DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50 4ti•r C $He� P L M L TO P L.
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 PERMIT40 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 INDUSTPIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNER'SPERMIT CONNECTION CHARGE FEE
$ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNE TDATE O N_T EAABOVECTED WDESCR BEDITH THE HER ISTINGAMED DWELLING APPROVALS .DATE INSPECTORS SIGNATURE
TO THE PUBLIC SE -
SIGNED THIS Rp Y OF t NEW HOUSE SEWER 9�p_ 5�/11/4ULD�i✓G
OWNER R� CONNECT ADDITIONAL
OWNERS G T BUILDING OR WORK
i SEPTIC TANK, SEEP, PIT(S)
ADDRES •� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE FJAD T14S APPLICATION CESSPOOL[IDRYWELL[:IAND STATE THAT THE ABOVE IS CORRECT 'kl,D AG EE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE E.6,ULATING ,
PLUMBING AND SEWERS - ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPE EGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANG
ELE C NTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA O HAT 1 AM THE LEGA NER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED REST E L P ERTY. BACKFILL SEPTIC TANKS C iZ , f �Ifl-ULDJA�/r.
TS CESSPOOLS (/!/
SIGNATU65� SEEP.PI
W�LLI J.FOX.COUNTY''ENGI EER 'VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
10 9 1 3 6 r OCT 1 P 4
4.5 0