HomeMy Public PortalAbout9502 LIVE OAK AVE_Sewer__ APPLICATION'
FOR PERMIT
6 8 E•663 12.54 '
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL,
Department of County Engineer n
County Of Lob Angeiee BUILDIN64
FN
RE SG �J Q .[ �y
WM. J. FOX, COUNTY ENGINEER T
CASSATT D. GRIFFIN,SUPT OF BUILDING ALITY
FOR APPLICANT T FII, IN RESTSS ST. /"
LEGAL ® p'
DESCRIPTION LOT NO. - O OWNER
BLOCK TRACT /'-« � MAIL 90%V0
ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT / CITY " �, TEL NO. , 777-1--l'-4-1.-l'-
USE OF
BUILDINGS /� ��..,,� DISTRICT NO. GROUP MAP
CONTRACTOR " ' j � , I I BK� P40
v
ADDRESS 0� P AJfY$
CONNECTION DATA
CITY cqiu:��,, t�iJ TEL. NO. P y STATION - DEPTH
❑ STATE "S'
' 'V' MA PPE •�FERENCE
REGISTRATION NO ` /3 /�. s ❑e6EYUNdY
TYPE OF CON E N LENGTH FROM
No. DESCRIPTION OF WORK FEE Y CURB P L. M L TO P L. y(p
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50 `J
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM - 1 00
CONNECT ADDITIONAL BLDG OR /��� JOB NO
_ WORK TO HOUSE SEWER 1 00 CO. IMP. N0.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO.;? 6j
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
r
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19- NEW HOUSE SEWER t
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT o -BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I' HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DES ED ESIDENTIAL R PERTY �w
TANKS
� ��.
vSEEP.BACKFPIT(S) CIILL CCESPOOLS
Jl� _
WILLIAM-J. FOX. COUNTY ENGINEER VALIDATION
BY DEPUTY �/!!2 2 G 2!s APR 4 4 4-5 O UTY41
•BY
BY ��
;® DEPUTY � DEPUTY