HomeMy Public PortalAbout6431 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
FOR APPLICANT TO FILL IN LOCALITY
BUILDING o
ADDRESS r � �✓ NEAREST
� CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. y =s G:z�yr yssrs�
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER � At
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MAIL USEZONE OCCUPANCY MAP
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CITY ;-.: L-42 L' TEL.NO.,,,J�? e�r�4;;71
CONTRACTOR = CO.IMP.NO.
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ADDRESS
JOB.N0.
CITY TEL.NO. TRUNK PERMIT NO.
STATE _
REGISTRATION NO. 0 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. -�— PERMIT NO.
BLOCK �; TRACT; ,: , 7- J� -•1 �'_" INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT =F N0.OF BLDGS. y
J` rl�C<' NOW ON LOT J CHARGES
USE OF
BUILDINGS rl� i '�'�" CONNECTION CHARGE FEE -NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 RECEIPT NO. I DATE I BY
NECTING TO
HOUSE SEWER CON
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. I
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 f
DNCONNECT AND ABANDON SEWER
ACONNECTION DATA
ND/OR DISPOSAL SYSTEM I.00
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
i UPPER - LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I 00
Y. CURB P.L. - M.L.TO P.L.
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AUTHORIZATION TOTAL FEE -
I 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.... -wi....19 NEW HOUSE SEWER
OWNER 0R`' CONNECT ADDITIONAL
OWNERS AGENT,:5�. F ' n.� -,.�.PrY..... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.� ....f:- Fz:�s< ... AND/OR AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
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 S EWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIB�SIDENI,IAL PROPERTY. BACKFILL SEPTIC TANKS(�
1� SEEP.PIT(S)0 CESSPOOLS
SIGNATURE----- `�'''� _ � ,
OF PERMITTEE 4 ! -----. ............ "''E+�
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