HomeMy Public PortalAbout5829 OAK AVE_Sewer__ DEPA JLlIENT OF COUMM E1ITGUMM X1:90 7 ER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J FOX COUNTY ENGINEER , ADDRESS �
FOR APPLICANT TO FILL IN LOCALITY _57
BUILDI
NG �Qr �� �' CROSS ST
CROSS ES
ADDRESS �) (( �
LOCALITY S DISTRICT NO SERIAL NO PERMIT NO c
NEAREST _,rA --� 3 O $
CROSS ST RE C IV Y Ready for loeoeotloa DDA/ISS S�
OWNER
MAIL A 20NE OCCUPANCY GK�W PG
ADDRESS
CITY TEL NO
CONTRACTOR cetAil Wxe,09 CO IMP NO / e �G C
ADDRESS JOB NO
CITY h '� TEL NO TRUNK PERMIT NO
REGISTRATION NO Ll-L STATE / /O `
ROAD PERMIT NO
LEGAL ! STATE ENCROACHMENT
DESCRIPTION LOT NO l PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
�/ 5D O OF B DGS
SIZE OF LOT /� c/ NOW ON LOT CHARGES
USE OF
BUILDINGS fi �, CONNECTION CHARGE EE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTINO TO
PUBLIC SEWERa $ 350 RECEIPT NO DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR XCEPTIO RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING I0 I D TE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC T8 AND/ OR ANKDRAINFIIELDAGE PIT OR 200or p
CESSPOOL—DRYWELL STATION ,5'- DEPTHdig
SPECIAL CONDITIONS ONLY 200 / 7 � MAPPEEFERENCE
• edof
r � LOWER
sw TYPE CCUR ECTIO M L TTo P FROM
OWNERS PERMIT ; I 00
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AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THISVEM44"'.
AY OF _S.�!_Lt 19 NEW HOUSE SEWER
OWNER OR _ {,{ CONNECT ADDITIONAL
OWNERS AGE �.l _ _ BUILDING OR WORK
ADDRESS
�_ _ _
AND/SEPTIOR DRTANAINF INSEEPFIELD
I HEREBY ACK WLED E THAT I HAVE READ IS APPLI CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQBY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFO IA 0 HAI AM THE LEGAL OWN
ER OF THE ABOV RIB E E D NTIAL PROPE Y BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)E] CESSPOOLS 1,1
OF PERMITTEE
40A642D 663 1/53