Loading...
HomeMy Public PortalAbout9515 LIVE OAK AVE_Sewer__ p��!' /p,]� I�g��.g� gee+ p��q PERMIT,wg��. 7 v 76AE-6D APPLICATION� � Y'®0 ■ ■ EY ■it0\IT 1 5&E•663 12.54 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of LOB Angeles BUILDING WM.J. FOX, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY (, FOR AP ICANT TO FILL IN CROSS S CROSS ST, s> LEGAL DESCRIPTION L OWNER 9-6 BLOCK TRACT �f' £ `a � MAIL zt- ADDRESS NO.OF BLDGS. �1 SIZE OF LOT Wr NOW ON LOT ® CITY TEL. NO. USE OF BUILDINGS �G/ �' DISTRICT/NO. GROUP MAP BK PG CONTRACTOR C�1 I �7 .y ADDRESS J CONNECTION DATA CIT ����� L. NO. �� STATION f)t ,,/ DEPTH /n � STATE '� /40 E REFERENCE REGISTRATION N0. w ❑ COUNTY �3AX UPPER tSNkEk- .TYPE O NE ION LENGTH FROM a�s NO. DESCRIPTION OF WORK FEE Y. CURS P.L. M.L.TO P.L. L HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $ 3.50 HOUSE SEWER CONNECTING TO _ P RIVATE.DISPOSAL SYSTEM 1.00 ,r CONNECT ADDITIONAL BLDG. OR - CO. IMP. N0. / JOB. NO. WORK C SEWER SEER 1.00 -/ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 _TRUNK PERMIT NO. ROAD PERMIT NO. „�•r� ��1� DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT '6 AND/OR DISPOSAL 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 CHAR S CONNECTION CHARGE FEE OWNER'S PERMT 1 00 AUTHORIZATION TOTAL FEE /! REIMBURSEMENT FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSP CTOR S SIGNATURE TO THE PUBLIC SEWEE SIGNED THIS-_-% /' AY OFAo E 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGEN BUILDING OR WORK �"`-�' � ,�° 'L-/,GS. jj+�, SEPTIC TANK, SEEP, P17(S) ADDRESS AND/OR _ DRAINFIELD I H EREVIrACKNOWLEDGE 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 ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA11-- ROPERTY. BACKFILL SEPTIC TTANKS❑ f SEEP. PIS) ❑ CESSPOOLS© ('r, SIGNATURE ✓%M' "(S o �� OF PERMITTEE WILLIAM J. FOX, COUNTY ENGINEER VALIDATION ":„1 zi-. 3 1 BY BY DEPUTY ' �iD�EP'U,7�Y+�s/p,� BY BY V J ® DEPUTY DEPUTY