HomeMy Public PortalAbout5815 OAK AVE_Sewer__ nErAxT>I�vT OF COUNTY FNGMEM SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS A G=JCli\ LDIN ¢ 04
WILLIAM J FOX. COUNTY ENGINEER I ADDRESS
FORILDINGS P �
DC NT TO 11.1. I NEAREST
ADRESS CROSS ST
LOCALITY DISTRICT NO SERIAL NO PERMIT NO c
NEAREST A—__ 2 ;-2
CROSS ST ti RE IV Ready for Inspection DAT ISSUE
OWNER s
MAIL 00, USiZdW OCCUPANCY NAP
ADDRESS BK PG /
CITY TEL NO
CONTRACTOR 3i 1 CO IMP NO
ADDRESS A '�s.1 �! JOB NO
CITY L TEL NO o(.!'T L/ TRUNK PERMIT NO
REGISTRATION NO B 8 COUNTY' ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOTNO PERMIT NO
BLOCK TRACT ! INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT "' NOW ON LOTS
CHAR6
USE OF %� I CONNECTION CHARGE FE
BUILDINGS
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER as 3 Be RECEIPT NO DTE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 I
CONNECT ADDITIONAL BLOO OR EXCEPTION RECO ED
WORK TO HOUSE SEWER fee NO I
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 100
AND%OR DISPOSAL SYSTEM SEWER 100 , CONNECTION DATA
PITS AND/OR SEEPAGE PIT
T OR 2.00 STATION /�
CE88POOL—DRYWELL + I 73• 4% DEPTH
SPECIAL CONDITIONS ONLY 200 O MANHOLEREFERENCE
OWER
PE OF CTION LENGTH FROM
OWNERS PERMIT $ I 00 URB $� M L TO P L ,���
AUTHORIZATION TOTAL FEE 30
1 NAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8 81ONATURE DATE
DWELLING TO THE f USLIC SEWS
SIGNED THIS . L DAY OF lab NEW HOUSE SEWER e k ,.$- /—
OWNER OR i CONNECT ADDITIONAL
OWNERS AG N _ _ _ BUILDING OR WORK
ADORE _ AND%OR DRAINFIELD PIT(S) f
'I-HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LI CESSPOOL❑ DRYWELL E3
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 P PERTY I BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S)E3 CESSPOOLS
OF PERMITTE
70A042A 603 7/