HomeMy Public PortalAbout6513 OAK AVE_Sewer__ SAE- ° APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer .
County of Los Angeles BUILDING g
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V1/tN.J. FOX,COUNTY ENGINEER --ADDRESS`-- ---a
CASSATT D.GRIFFIN:SUP*T OF BUILDING LOCALITY
FOR APPLICANT TO F'IL IN CROSS S
c�as5 ST.
LEGAL we
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DESCRIPTIO_N LOT �' -OWNER � &.
BLOCK TRACT q( � g �-`y MASE -
f Y `. ADDRE55
NO. OF BLDGS.
_ SIZE OF LOT NOW ON LOT -I CITY L. N0. -
USE OF
BUILDINGS DISTRICT NO. GROUP `r MAP
-- --
- 9K PG
CONTRACTOR
ADDRESSC®lVitiCTI�3N DATA i
CITY �,�s, ,y, ,aa"'- TEL. NO. s - _ ., .�'� _ STATION — /< d��,+ DEPTH.
E. a-75TATE MANHOLE REFERENCE �- „ UPPE _
REGISTRATION N0. -,r!_ .� -��'�,' ❑ COUNTY -----. r .`Y"___ ..1a .__'_`_ .`_. _..._ rt2
NO. DESCRIPTION OF WORK. — FEE -- --.— --- —� -. .— _.---.---
HOUSE SE11ER CONNECTING TO ~�. �a - TYPE OF 'NECTION LENGTH{-PROM
PUnLiC SEVERct _$ 3.50
p �' — P.LM.L. TO P L_-- = -
_ _ � -, St - -
HOUSE SE"N ER CONI ECT(NG TO -
--^(_ PRIVATE DISPOSAL SYSTEM 1.00 __ —_—. -- -----
1( CONNECT RDD TIOP AL BLDG. OR P C N0.
WORK TO HOUSE SEWER_ 1.00 O. 1}If'.. N0. .lOB N0.
__. - I ----- - --.-. ._,
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM �1_00 f -.. TRUNK PERMIT NO. ROAD PERIA!T
DISCONNECT AND ABANDON SEWER I STATE..ENCROACHM ENT
_ ANL/CR DISPOSAL SYST c,I 1.00 1 PERM IT N0.
Se PTIC TANK,SEEPAGE PIT OR^ - - —'- �- -"- -"--'---'— - ---'--- ---
P1TS AND/OR DRAINFIELD .UO WASTE AL
CESSPOOL-DRYNIELL
'-- - - - -
---� SPECIAL CONDITIONS ONLY -2.00 _._ ---__--_—�-- CHAECEa
�a
�� � PERMITPERMIT --- -
CONNECTION CHARGE FEE
1 00 ------ ----------- ----- --
AUTI-IORIZATION � TOTAL FEE �� � ;�> REIMBURSEMENT FEE
1HAVE. IH1S DATE CONTRACTED WITH THE IiEREI NAYED CON-
TR
"CTO' TO CONNECT THE ABOVE DESCRIBED EXISTING U SELL NG APPROVALS DATE" INSPECTOR'S SIGNATURE
TO HE PUBLIC SEWERNEW HOUSE SEWER 1
SIGNED THIS ewDAY
OWNER OR L g, -� CONNECT ADDITIONAL
OWNERS AGENT ' BUILDING ORR WORK
SEPTIC TANK,SEEP, PI'L(S)
F,DORESS�-,.� AND/OR DRAINFIELO
I HEREBY ACKNOWLEDGE THAT I HAVE. READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS C09R.ECT AND AGREE TO COMPLY
WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER 6R —�
PLUMBING AND SEWERS. AERSEWAGE REPAIR,
DISPOSS SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -'---D-__.-�_.—
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABAN60N HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. - - —. - ----_'"'- -
BAGKFILL SEPTIC TANKS La i
SEEP. PIT(5.i [] CESSPOOLS f_J
_
SIGNATURE "`
OF PERMITTEE ��-_�---
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF f LBG. INSPECTOR