HomeMy Public PortalAbout6332 OAK AVE_Sewer__ .DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
` DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER 1 BUILDING
ADDRESS
FOR APPLICANT TO FILL 1N LOCALITY
BUILDING A NEAREST r
ADDRESS �. / CROSS ST.
LOCALITY f yF ( m r F DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTP
CROSS ST. � � ��� �- '�• <`
_ _ J RECEIVED BY Ready for Inspection DATE ISSUED
OWNERi" 1t
MAIL USE ZONE I OCCUPANCY MAP
ADDRESS Tt _ BK PG
I
CITY _ � ��. ;A'_EL.ND.
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB NO.
CITY TEL.NO.
TRUNK PERMIT NO.
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.8F BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO.I DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
I HOUSESEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK T_0 HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- 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 DRAI_NFIELD 2.00 STATION - DEPTH
—CESSPOOL—DRYWELL r `
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER L(SWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 GuRa P.L.- M.L.TO P.L.
AUTHORIZATION 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.......-_............_..................19........ NEW HOUSE SEWER I '
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------............._.......---•---..•...:............................._......._ BUILDING OR WORK 1
ADDRESS,.- ------------------------------ SEPTIC TANK,SEEP.PIT(S)
--•--•-•------•------••----- AND/OR DRAINFtELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL 0
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED 8Y LOS ANGELES COUNTY _ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[] CESSPOOLS Ej
OF PERMITTEE---..----------- - .... •-•••-•-----------•----- ---.._•--
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