HomeMy Public PortalAbout5937 OAK AVE_Sewer__ 'sag"60 1284 APPLICATION FOR PERMIT 1
I DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dlpet[ "lol r .CatiII SnginOes BUILDING
IY � ADDRESS •
,¢ WM J FOX COUNTY ENGINEER
r CASSATT D GRIFFIN SUP T OF BUILDINGLOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSSLEGA
ST
DESCRIPTION LOT NOI. 0' OWNER
BLOCK TRACT G e 4 / MAIL
NO OF BLDGS ADDRE S
SIZE OF LOT SO NOW ON LOT CITY TEL NO i
USE OF
BUILDINGS DISTRICT NO GROUP YAP
SK PG
CONTRALTO r 110- 162e
ADDRESS CONNECTION DATA
r
CITY � TEL NO STATION f r DEPTH
STATE �� MAIINOtE-REFERENCE
REGISTRATION NO /j�/ [3 COUNTY • • • P � .tOlMEit
TYP NECTIOI--- LENGTH FROM
NO DESCRIPTION OF WO FEE Y UR P L M L TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER S 350 UNA_
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING
_ SEWEROR DISPOSAL SYSTEM 100 TRUNK PERMIT NO ROAD PERMIT NO QJEW
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 CHARGES
CONNECTION CHARGE FEF
OWNEWS PERPOT s I 00
AUTHORIZATION TOTAL FSE - REIMBURSEMENT FEE
i HAVE THIS DATE CONTRACTED WITH THE HEREIN NA ED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIN DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SE R
SIGNED Ti DAY OF� NEW HOUSE SEWEROWNE - W�
CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
EPTIC TANK SEEP
ADDRESS T AND/OR DRAINFIELDPIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[3DRYWELL 13
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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THA 1 AN THE LEGAL NER OF THB AB ABANDON HOUSE SEWER
CRiBEDESID PROP TY ,r / BACKFILL SE C TANKS❑
Rf�/j !1/'c`i�lf BEEP P(T S CESSPOOLS
!•GNATU E
O PERY]TTE C t
WILLIAM J FOX COUNTY ENGINEER VALIDATION
BY (�:� a :) I IiTMU 5 ,T
DEPUTY DEPUTY
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I ® DEPUTY fzpu