HomeMy Public PortalAbout9658 LIVE OAK AVE_Sewer__ bEPARTMENT.OF COUNT' ENGINEER
• `.SEES®SEWAGE DISPOSAL, -
DIVISION OF 13UILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES I
WILLIAM Jr BUILDING FOX, COUNTY ENGINEER I ADDRESS
FOR APPLICANT TO FILL IN. LOCALITY
BUILDING 7 NEAREST
ADDRESS "� ^S� M�'C�`✓/t. �Lt!`�i CROSS ST.
LOCALITY ! DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
� / 7�
5y A S
CROSS ST.
RECEIVED BY Ready for Inspection. DATE ISSUED-.
OWNER
MAIL q ` �.- /� j G
ADDRESS /" S � �-� USE ZONE OCCUPAnN�CQY._ BK MAP PG
GITYTEL.NO. �'/ Q Y
CONTRACTORAA I CO.IMP.N0.
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ADDRESS (��i� /V � Pl.X.r _ t JOB.N0.
CITYy4 (llllTE 0: C� ti �- �� j TRUNK PERMIT N0.
REGISTRATIO N0. 7/7 �. COUNTYROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 2-7 `; PERMIT NO.
BLOCK TRACT / ^!' �L INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT -NO.OF BLDGS. a, i
NOW ON LOT t:t,__ ` CHARGES,USE OF
/
BUILDINGS f CONNECTIO CHARGE FEE
N0. DESCRIPTION O ORK- FEE iEiFi6URSEMEN FEE '
HOUSE SEINER CONNECTING TO
_ PUBLIC$EWER .__ Q,¢ 3:50RECEIPT NO: �\' DATE [BY.'`-- "
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR ,c EXCEPTION RECORDED
WORK TQHOUSE SEWER I.00 N0. / DATE B_Y
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 /I
DISCONNECT AND ABANDON SEWER I
AND/OR DISPOSAL SYSTEM 1.00 1 CONNECTION DATA
SEPTIC TANK,SEEPAGE.PIT OR
PITS AND/OR DRAINFIELD- 2.00 J .STATION � � �� L DEPTH '7
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 I ' MANHOLE REFERENCE
J UPPER 'L°OWER�
TYPE OF CONNECTION LENGTH FROM
Y.� CURB —IRA- - M.L.TO P.L.
OWNERSI PERMIT -$ 00 ; Qw R't, /j
.�P P �!/S4 .
AUTHORIZATION TOTAL FEE I (/
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED ����� ¢ _
HAVE
TO:"CONNECT THE ABOVE DESCRIBED EXISTING,] APPROVALS INSPECTOR'SSIGNATURE DATE
,DWELLING TO THE PUBLIC SEWER e/
j � NEW HOUSE SEWER
SIGNED THIS F. ,{...DAY/ F.... C f� 19._ -7 I e,/l
OWNER OR �C tJ.'t%C e /YY� /�J �gy�7 BUILDICONNEG ORW ZONAL
OWNERS AGENT------------------- -- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS. ---------------•-------•----........:. ...... AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL n''DRYWELL
CATION AND STATE THAT"THE'ABOVE IS,CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER;REPAIR,SEWER OR •
REGULATING-PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)❑ CESSPOOLS40� awwken�
SIGNATURE
OF PERM ITTEE .if/ v - '
76A642D 663 1/53