HomeMy Public PortalAbout9666 LIVE OAK AVE_Sewer__ E
9&E--66669 3.54 APPLI A`rION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEINER-SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING
ADDRESS �,�
WM.J. FOX. COUNTY ENGINEER
°® CASSATT D.GRIFFIN, SUPT of BUILDING - LOCALITY
NEAREST
,
FOR APPLICANT TO FILL IN
ceoss sr. 46
LEGAL i
OWNER
DESCRIPTION LOT NO. A a s a Q k
BLOCK MAIL
ADDRESS �. s
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF MENINNEMORIM
BUILDIN DISTRICT NO.
GROUP MAP�f� I ell; BK PG
CONTRACTOR
ADDRESS J CONNECTION DATA
C _ TEL. NO. STATION 9 +Z)a I DEPTH 6
❑ STATE MANHOLE REFERENCE
REGI ZRATION NO. U X ❑ COUNTY OVJ
No. DESCRIPTI N OF WORK FEE
/ HOUSE SEWER CONNECTING TOTYPE ECTION LENGTH FRO
Ye-- M
PUBLIC SEWER C� $ 3.50 -- CURB �' M.L. TO .L.
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR //''�� P. C. N
.
WORK TO HOUSE SEWER 1.00 C ! P, NO.��Q(G7 JOB N0.
ALTER OR REPAIR EXISTING 1®TRUNK PERMIT NO. ROAD PERMIT NO.
SEWER OR DISPOSAL SYSTEM 1.00 u
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD - -3.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S S 1 00
AUTHORIZATION TOTAL FEE1 _6 �4 REIMBURSEMENT FEE
TRACTORIHAVE CONNECDATE T THEA NTRAABODVEWDESCRBED EXISTINGITH THE HEREIN A DWDELLI G APPROVALS DATE INSP. CTOR'S SIGNATURE
TO THE PUBLIC S W R
NEW HOUSE SEWER
SIGNED THIS DAY
OWNER OR CONNECT ADDITIONAL t
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS z777 AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND F. n
CALIFORNIA OR THAT I AM THE AL OWNER OF THE ABOVE ABANDON HOUSE SEWER A
DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS❑ I
SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
L 4-
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FLBG. INSPECTOR
"' 3 1 5 5 " JUL 11 4