HomeMy Public PortalAbout6249 OAK AVE_Sewer__ DEPAWRXIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL.
DIVISION OF BUILDING AND SAFETY - PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING 7 f
ADDRESS � t 0 ,, rd-;
FO APPLICANT TO�F/ L IN ,5�'"' LOCALITY V l'
ADDRESS /`�, �� CROSS ST. -�� 4d�
LOCALITY AQ•� � DI$TRI..mpo. SERIAL NO. PERMIT NO.
NEAREST ® , .� 6. A —� ,Ire 7e7 ZJS
CROSS ST. ` - RECEIVE BY0 Ready for Inspection f DA..ISSUE
OWNERMAIL
ADDRESS USE ZONE OCCUPANCY /
BK PG
CITY TEL.NO. � » a/
CONTRACTOR 6;12
_ CO.IMP.NO, j
ADDRESS JOB NO. ---- - -
CITY �� TEL.N ,�� TRUNK PERMIT NO.TATE
- -
REGISTRATION NO. COUNTY
ROAD PERMIT N0. 2 ! C!
DESCRIPTION LOT NO.� 7,7 ®l��d� ,G�z STATE ENCROACHMENT
PERMIT NO.
BLOCK g -' TRACTW� 37/--o�1/ INDUSTRIAL
WASTE APPROVAL _
SIZE OF LOT, NOW ON LOTS,� CHARGES
USE OF 17 j y v
BUILDINGS ✓'"�� CONNECTI.ON CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
REIMBURSEMENT FEE
PUBLIC SEWER 1; 3.80 RECEIPT NO: ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL.BLDO.OR EXCEP ION R ORDED
WORK.TO HOUSE SEWER I.00
ALTER OR REPAIR EXISTING NO. DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR _ _DISPOSAL SYSTEM 1.00 CONNECTION DATA s
SEPTIC TANK,SEEPAGE PIT OR �y
PITS AND/OR DRAINFIELD 2.00 STATION fi DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 .f' Jt/ MANHOLE REFERENO,Er
.SFA r
TYPE0 €CTION LENGTH FROM t_ .,�a,�✓
OWNERS 'PERMIT ; 1 00 CuRB y -4�4.. M.L.T0.P.L.
AUTHORIZATION TOTAL FEE -!?1 ,51-0
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOWSSIGNAT RE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS—.---.--.DAY 19....._. NEW HOUSE SEWER �`�, /A«, ,a � �� ►�`
OWNER OR CONNECT ADDITIONAL a
OWNERS AGENT..._......_:....._.._.._.........._.._..............__.._.._._ BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS...................... .................................. AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL f]
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND ATE LAWS ALTER,REPAIR SEWER OR
REGULATING PLU ING'AND SEWERS. SEWAGE DISP06ALSYSTEM
1 HEREBY IFY' THAT 1 AM PROPERfE
EGISTERED
AND/OR LICE D AS REQUIRED BY LOS ALES COUNTY DISCONNECT PLUG AND.
AND STATE CALIFOR IA OR THAT 1 AMLEGAL OWN- ABANDON HOUSE SEWER
ER OF TN A E DPBED RESIDENT PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT•(S)[.CESSPONE3
SIONAT RE �d�
OF PERMITT ..._. .._.._.. .g.._._,_..._ �..__�._.. ._. .�. ...
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