HomeMy Public PortalAbout6437 OAK AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER BUILDING
ADDRESS
FOR APPLICANT TO FIL IN LOCALITY
BUILDING (� ` f NEAREST
ADDRESS CROSS ST.
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY •.,, '' � , ry �� C
NEAREST S ( A 4 L�/ y J
CROSS ST r �7. r y� ECEIVLBY Ready for Inaoeoti/on DATE ISSUED
OWNER
ADDRESS (ciL�� �l _ USE ZONE OCCUPANCY MAP
BK PG
CITY ' l LJ. .NO.
CONTR CTOR ✓ y F u CO.IMP.N0. ,'Z 77- 2
ADDRESS , JOB.N0.
CITY TELAO. l- t [!�' =tS
— TRUNK PERMIT N0.
y ❑ STATE
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO, z1 73
LEGAL cv/(� i(•'f"f; S ` STATE ENCROACHMENT
DESCRIPTION LOT NO. /yt. c �C� PERMIT NO.
BLOCK TRACT'A,-,sr✓ C �, �+, INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BL DGS. /
NOW ON LOT r CHARGES
USE OF ��,' ���
BUILDINGS T I✓ �� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 (> RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM1.00
CONNECT ADDITIONAL BLDG._OR EXCEPTION RECORDED
__WORK TO HOUSE SEWER 1.00
LTER OR REPAIR EXISTING NO. I DATE I BY
A
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 DRAINFIEL_D 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.I, M.L.TO P.L.
OWNERS PERMIT $ I 1 00 {
14
AUTHORIZATION TOTAL FEE �G l".
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED �' b
HAVE
TO CONNECT THE ABOVF4ESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH€ PUBLIC SEWER—
SIGNED THIS_- /- -------DAY O .- .' - 19. 1-� NEW HOUSE SEWER
OR CONNECT ADDITIONAL
OW ERS AGENT 1 � y, J -�:...•--_- BUILDING OR WORK
SEPTIC'' -.-.. ..--
ADORESS.__zc_i j �-- `-------------------. AND/OR DRAINFIELD PIT(S)
1 HEREBY ACKNOWLEDGE THATl, HAJE READ THIS APPLI- CESSPOOL C] DRYWELL
CATION kND STATE THAT THE ABOVE I •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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT IAM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)� CESSPOOLS[]
SIGNATURE < ,-
OF PERMITTEE .- .,, Z, , r/� .-..,(/5 -- ✓c` �
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