HomeMy Public PortalAbout6153 OAK AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FQR APPLICANT TO.FILL IN LOCALITY
BUILDING
A ' �' � ✓y/ . NEAREST
DDRESS
CROSS ST.
LOCALITY / DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST ,�r�''� /�rd�— A S
CROSS ST. C7�®-r'_ , /tf� L✓f' C
RECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
� LL/��
ADDRESS .- JC:+> -G USEZONE OCCUPANCY BK MAP PG
CITY EL.NO
CONTRACTOR
CO.IMP.N0.
ADDRESS -
- JOB.N0.
CITY %r TEL.NO. K+:7
TRUNK PERMIT NO.
REGISTRATION NO. TATE
COUNTY ROAD PERMIT N0. ;
'7
LEGAL ' STATE ENCROACHMENT
DESCRIPTION LOT N Nr` PERMIT NO.
BLOCK T6CT � INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
>r,m�.�16iV NOW ON LOT CHARGES
USE OF
r .-mle_ �.
BUILDINGS .. -,� � s CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ = 3.50 I RECEIPT NO. ( DATE I BY
HOUSE SEWER CONNECTING TO i
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00:L I
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_-PITS AND/OR DRAINFIELD 2.00 I STATION - DEPTH
CESSPOOL—DRYWELL I
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER L$W�
! TYPE OF CONNECTIONLENGTH FROM
CURB P.L, M.L.TO P.L.
OWNERS PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC ,SEWER �
SIGNED THIS.___'�-.�'�__...---DAY OF..''�!._ .lG ...___.._.19`rIg" ' NEW HOUSE SEWER
OWNER ORt CONNECT ADDITIONAL
g y� „ BUILDING OR WORK
OWNERS AGENT�eel,0 y' .. �__t ...................... SEPTIC TANK,SEEP.PIT(S)
ADDRESS.... -----7__...-----.........._. AND/OR DRAINFIELD
CAI HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL(] DRYWELL
TION 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 IAM 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 DESCRI ED RESIDENT*L PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)o CESSPOOLS
F PERMITTEE 4t ,_'... :. _l1Ze
L0=L �
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