HomeMy Public PortalAbout6440 OAK AVE_Sewer__ '6A 642D - CE808 -- 8/73 APPLICATIbN FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B
UILDING
'"`i '
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO< t� /•_--�' OWNER Or -_yam
/ MAIL
BLOCK TRACT 1t'3 -G'.� ADDRESS
6_X �. � NO< OF BLDGS.
SIZE OF LOT /� NOW ON LOT CITY
_4
fiL. NO.
USE OF
BUILDINGSDISTRICT NO. OUP MAP PR ESED BY
_ PS
DONT
ADDRESS ONNECTION DATA
CITYy =` TEL. NO, y; ' STATION DEPTH'
UPPER
STATE CL �.+*. MANHOLE REFERENCE
LICENSE NO: �-~- ��� GLASS E-- LOWER
NO. ---DESCRIPTION OF WOR a FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P,L. M.L.TO P.L.
PUBLIC SEWER 0 $7<00
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.
PfT5 ANO/OR DRAINFIELD @ ;10,00
CO.IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TOs TRUNK PERMIT NO, ROAD PERMIT NO,
PRIVATE DISPOSAL SYSTEM @ ;3.00
CONNECT ADDITIONAL BL G.OR L, AFFIDAVIT wA1Y6M XACCM[NT RECORD.INS
OF>�.i� TR.NO. DATE
-WHOUSE SEWER Z�. .V,kkt(o ;3,00 .. ..
OVERFLOW SEEPAGE PIT,DRAINFIELD i O
EXTN..CESSPOOL.DRYWELL. ;5,.00 V
ALTER.REPAIR OR ABANDON HOUSE HWY.OR 5T.WIDENING
SEWER OR DISPOSAL SYSTEM 43.00
$ STATE ENCROACHMENT - CD
MANHOLE PERM IT NO: ��r"`y'7.-�'y i.e`.". .y...... +I':-;%'�'2.i�- = LLI
7.00
-------- INDUSTRIAL p„
WASTE A.PPROVAit,�",. ,„ , - , / _ 00
OWNER'S PERMIT s ' A(�i' cHSRcfiB .-
-_ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE �`_'�- -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC Sr AA APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF19
OWNER ORNEW HOUSE SEWER
OWNERS AGENT' li
-'—
CONNECT ADDITIONAL
BUILDING OR WORK -
ADORESS. _
-� ASEPTIC TANK,SEEP.P!T(S)
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
ANb STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .-
WITHALL COUNTY ORDINANCE5 AND STATE LAWS REGULATING
PLUMING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFC.RNIA. OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO OtSCON NECT PLUG AND
RESIDE IN, THE .4 Fi,DESCR LSED RESIDENTIAL P RFY. A8ANDON HOUSE SEWER
SIGNATURE ��y`'� f off,e BACKFILL SEPTIC TANKS ❑
OF FEQMTTTE ' "`-, ._>y ��}y o�.S�EEP.PIT$) ❑ CESSPOOLS C]
fir'f
VALIDATION ION y''e M.tl. CASH
3 5
Dt',PARTMENT OF COU*N-rY ENGINYXR SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COU*ITY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGADDRESS
S
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING �"�" NEAREST
ADRESSr� C CROSS ST.
LOCALITY r e/ DISTRICT NO SERIAL NO. PERMIT NO. c
NEAREST J `�
CROSS ST. —
��',`�s✓ RECEIVED BY Ready for Inspection DATEISSUED
OWNERj+f'y .a L.✓lC.��` r �'�cL1'
MAIL y USE ZONE OCCUPANCY tMAcf -`
ADDRESS �� '`a.s!inel BK PG
CITY TELAO.
CONTRACTO5�» �f err , CO.IMP.NO,
ADORES I?l,/ X r s� JOB.N0.
CITY ; -V TEL.N0 -�Tz TRUNK PERMIT N0.
STATE
REGISTRATION NO. R-COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT _-
DESCRIPTION LOT N0. PERMIT NO. _
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
_ NOW ON LOT
USE OF `� CONNECTION CHARGE FU
BUILDINGS .e'r' ,:fi / .__"e,
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER • @ $ 3.50 RECEIPT NO. DATE +BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AHD ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 i CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER i trrY i�
TYPE OF CONNECTION LENGTH FROM _r
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT s i 00 _
AUTHORIZATION TOTAL FEE
CONTRACTORS DATE TO CONNECT TAE ABOVE DESCRIBEDED WITH THE EXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER I I'
' y NEW HOUSE SEWER
SIGNED THIS_.r ad -d Y OF � _19rLf
OWNER OR �Z-c
CONNECT ADDITIONAL
OWNERS AGENT rr .. BUILDING OR WORK
/!✓ SEPTIC TANK,SEEP.PITS)
ADDRESS...._ �.'
:'.._,..___.._._..._. AND/OR DRAINFIELD
I HEREBY ACKNOWL DGE THAT 1 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE 103r.SCRIBED 5.FWDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E
SIGNATURE SEEP.PIT(S)� CESSPOOLS
OFPERM tTTEEy_ iIf.
2GA642A 663 7/53