HomeMy Public PortalAbout9561 LIVE OAK AVE_Sewer__ DEP"KMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLIC_A TO FILL IN LOCALITYBUILDING
NEAREST
ADDRESS o�r� -B CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST f' A ICO///?IT� (0 J
CROSS ST.
ECEIVED BY Ready for Inspection DATOSSIPED
OWNER ` v` P Ag
.an
MAIL
ADDRESS USE ZON OCCUPANCY -MAP PG
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CITY% EL-NO _ K f'Lr7
CONTRACTOR
CO.IMP.N0.
ADDRESS 4
"= JOB NO.
CITY /z_ TTEL.NO/�� ��a ' TRUNK PERMIT NO.�
el 6 ESTATE
REGISTRATION NO. _ jj ❑ COUNTY ROAD PERMIT NO.
LEGAL T
DESCRIPTION LOT N0. PERMIT NO.
STATE ENCROACHMENT
BLOCK TRACT ��o' CSS WASTE APPROVAL
SIZE OF LOT ® S NOW ON LOTS � �� CHARGES
USE OF
BUILDINGS CTIO -CkARGE FEE
No. DESCRIPTION OF WOR FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE-,�,_ _
PUBLICSEWER @ $ 3.50 RECEIPT NO. fY TE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR j
PITS AND/OR DRAINFIELD 2.00 STATION �76 DEPTH e�
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00MANHOLE REFERENCE
oS -.51SR - LOWER
TYPE OF CONNECTI!,, LENGTH FROM
PERMIT $ 1 00 Y. `e-L,1 M.L.TO P.L.
OWNERS -�
AUTHORIZATION TOTAL FEE
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF..............--....-..................19-... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..................................................................... __ BUILDING OR WORK
..............--
..__
________________------__ SEPTIC TANK.SEEP.PIT(S)
ADDRESS
•-----------------•-----------------------------------• - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE El
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE SCRIBED ESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)❑ CESSPOOLS[:]
SIGNATOF PE
URE
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