HomeMy Public PortalAbout6211-6211 1/2 OAK AVE_Sewer__ DEPAWVUENT 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
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS _ -"� CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST --------- - - -- A S
CROSS ST___ RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USEZONE OCCUPANCY MA:
BK PG
CITY TEL.NO. I(
CONTRACTOR
— CO.IMP.NO.
ADDRESS
-- -- JOB NO.
CITY TEL.NO.
TRUNK PERMIT N0.
REGISTRATION NO. r1 STATE
COUNTY ROAD PERMIT NO,
LEGAL
DESCRIPTION LOT No. STATE ENCROACHMENT
--- -- --- PERMIT NO.
BLOCK TRACT INDUSTRIAL
-^- -- WASTE APPROVAL
SIZE OF L07 NO.OF SLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS '`" CONNECTION CHARGE FEE
NO.j DESCRIPTION 13F WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER_ @ $ 3.50 RECEIPT N0. ! DATE i BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
'CONNECT ADDITIONAL BLDIN.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE (BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNCT EAND ABANDOSEWER
AND/OR DISPOSAL SYSTEM 1.00
SEPTIC TANK,SEEPAGE PIT OR CONNECTION DATA
_PITS ANO/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—O RYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y, CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS..::. -_ __.._DAY OF: _ ........... ._I9; ... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.------- ---------- _..-----_ BUILDING OR WORK
ADDRESS . SEPTIC TANK,SEEP.PIT(S)
- ... -•--.. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL E
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 1 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 PROPERTY. BACKFILLSEPTIC TANKS
�
SEEP.p1T(S)� CESSPOOLS
SIGNATURE
OF PERMITTEE................:.----------------- J
76A6121) 663 1/53