HomeMy Public PortalAbout6150 OAK AVE_Sewer__ r:_'DEPARMKIM OF COMqTY EvG>a >Es SEWER—SEWAGE DISPOSAL
DIVISION OF EDILDING AD SAFETY PERMITAPPLICATIONOff' LOS ANG=S
`t WILLIAM J. FOX, COUNTY ENGINEERBUILDING
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'ADDRESS ,�•; � ;f� JI r �/` ,i�� 7
FOR APPLICANT TO FILL IN LOCALITY —,.�? f •��-!,,'; t__ _'_
BUILDING / ir• r NEAREST
ADDRESS t., �, , "�I.ro- . f-fi` 1�� CROSS ST. r -✓ d )rs, j� .3- ,�_ �_." i
LOCALITY' 4 t / DISTRICT N0. SERIAL N0: PERMIT N0.
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A16547 125;.-1,4-1s
or
CROSS ST.��jr �~
,t RECEIV D BY Ready for Inspedtion DATE
IISSUED
OWNER t.+; ' ,o'MAIL
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ADDRESS '�� USEiONE OCCUPANCY MAP'
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CITY TEL.PoO.
CONTRACTOR :ryx �
CO.IMP.N0. .a Z , 7f
ADDRESS -
-� JOB.NO.
CITY ��� TEL.NO.
TRUNK PERMIT N0.
STATE
REGISTRATION N0. ®. COUNTY . ROAD PERMIT NO.LEGAL
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DESCRIPTION L0-T-S0.pfiw �'! 3� STATE ENCROACHMENT,
_ `•� PERMIT NO.
BLOCK TRACTa-^-' INDUSTRIAL r..—.----- .,
WASTE APPROVAL
SIZE OF LOT NO.OF BLDG&
NOW ON LOT _ CHARGES
USE OF a i '
BUILDINGS ��j CON TION CHARGE:FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
REIMBURSEM E
PUBLIC SEWER @ $ L50 f RECEIPT NO. TE I BY
HOUSE SEWER CONNECTING TO-
PRIVATE DISPOSAL SYSTEM x.1.00
CONNECT ADDITIONAL BLDG.O$ - - - ' --EXCEPTION RECORpED
WORK TO HOUSE SEWER 1.00
ALTER:OR REPAIR EXISTING N0. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT-AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM -1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION /L- DEPT14
CESSPOOL—DRYW ELL.
SPECIAL CONDITIONS ONLY 2.00f MANHOLE REFERS E s f
L UPPER , :l
URBECTIOtel MEL. Tr
P. L.OM
OWNERS PERMIT -_
_z-
AUTHORIZATION TOTAL FEE -
iHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED.
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE.
DWELLING TO THE PUBLIC SEWER'f'� S -•
SIGNED THI$r ..DAY OF. /X: .:"4=:1 ......-,._19. ..t NEW HOUSE SEWER . r -2 -j
OWNER OR lr �� CONNECT ADDITIONAL
OWNERS AGENT..-..�-..._ °'�� ^�---� ; BUILDING OR WORK
................_.,...-_....�.-��.�i r...--....-_........
n . SEPTIC TANK,SEEP.PIT(S)
ADDRESS.... f. -1__._.� ..__ !... ��! Ct; AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYW.ELL
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS.REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND -
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOV amESC�'ED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
g \ ` SEEP.PIT(S)� CESSPOOLS
? SIGNATURE'___' t� V�•.-r,�7 �_-�
OFPERMITSEE...=.... r_......_ -..... .7......... ......-......__-_-...
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