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HomeMy Public PortalAbout6472 LIVIA AVE_Sewer__ r 76A 6420 - CE808 - 9/73 APPLOCATOFOR P�' MOT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING c ADDRESS J LOCALITY NEAREST FOR APPLICANT TO FILL IN =ROSS BT LEGAL DESCRIPTION LOT NO OWNER IL MAIL ^O60 BLOCK TRACTuo4 ADDRESS (� NO OF BLDGb SIZE OF LOT14q NOW ON LOT CITY�V EL NO S USE OF BUILDINGS DISTRICT NO G P BK PG MAP SED BY 7 GONTRACTOR (/(� ADDRESS CONNECTION DATA CITY TEL NO ST TION DEPTH STATE LIC UPPER LICENSE NO CLASS M NHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL ML TOP L PUBLIC SEWER $7.00 PC NO SEPTIC TANK SEEPAGE PIT OR CO IMP JOB NO PITS AND/OR DRAINFIELD ® STOOD HOUSE SEWER CONNECTING TO TRUNK PERMIT NO----_ ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM 3300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIV[A [ASIMEN' RECORD 1 NO DATE Wl>�0 HOUSE SEWER $300 d OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL $5 00 U ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM S300 STATE ENCROACHMENT C) MANHOLE PERMIT NO W 0 $7.00 INDUSTRIAL N WASTE APPROVAL OSIER'S PERM s �jp� CHARGES — AUTHORMATIOIV I TOTAL FSE 6d CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON, REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER n OWNERS AGENT CONNECT ADDITIONAL , ADDRESS BUILDING OR WORK SEPTIC TANKSEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFQRN IA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A VE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK, M.O. CASH 388iMAY 191e 0 9.00 &6 �V�/ APPLICATION (py ® ® N FOR meq! 7 � DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL - Department of County Engineer (� County of LOB Angeles 7-,Y,7;7 ADDRESS WM. J. FOX, COUNTY ENGINEER LD' CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY r� yp,,�:V FOR APPLICANT TO FILL IN NEAREST F° CROSS ST. L17 LEGAL LEGAL ix DESCRIPTION LOT NO. i / !f' y� OWNER � t � L.�J•L-� f, BLOCK TRACT , �{f AIL r, p DRESSL��1,-d L--J NO.OF BLDGS. SIZE OF LOT NOW ON LOT � hiJL .,[ TEL N . j USE OF yMINIM BUILDINGS �"`�"+`-�'' DISTRICT NO. GROUP MAP BK PG CONTRACTOR ADDRESS 07!i � WF' CONNECTION DATA CI ` TEL. , `,Tj 1 STATION DEPTH ESTATE d MANHOLE REFERENCE l�/ REGISTRATION N0. '© / ❑ COUNTY_ UPPER L TYPE CONNECT15V LENGTH FROM 5--, NO. DESCRIPTION OF WORK FEE Y CURB /�� M HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3 50 1 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR S ' _CO. IMP. NO. j�O� JOB NO WORK TO HOUSE SEWER 1 00 (. 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 _ ITS AND/OR DRAINFIELD 2 00 INDUSTRIAL ' CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHA S CONNECTION CHARGE FEE OWNERS PERbUT $ 1 00 AUTHORIZATION TOTAL FEE '� S`(, REIMBURSEMENT IZ TRACTORHAVE T TOS CONNECTDATE ONTRTHEA ABOOVE DESCRIBED THE H ESCRBEDH EXISTING NAMED DWELLING APPROVALS DATE INSPECTOR IGNATURE TO THE PUBLIC SEWED 19�L�'�' 11 A SIGNED THIS DAY OF NEW HOUSE SEWER 8-I�_ 'tom �0.kv OWNER OR„ CONNECT ADDITIONAL �W s' OWNERS AGEINT - r3U1LDING OR WORK i r SEPTIC TANK, SEEP, PIT(S) ADDRESS - f zf/`� F�w AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I ¢I VE READ THY 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 9--221-17 DESCRIBED RESIDENTIAL P TY. BACKFILL ❑SEPTIC CE SPOO l�i-2 1-17 SIGNATURE v OF PERMITTEE;;�� ' WILLIAM J. FOX, COUNTY ENGINEER VALIDATION BY o oY6 9 3 AUG 16 4 5.5 0 DEPUTY DEPUTY BY r BY ® DEPUTY DEPUTY