HomeMy Public PortalAbout6526 OAK AVE_Sewer__ DOF OOUNTY ENODFEE13 SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUP= OF IM ANGELES
WILLIAM J. FOX, COUNTY ENGINEERBUILDING
'ADDREBB
FOR APPLICANT TO FILL IN LOCALITY ,
BUILDING � NEAREST
ADDRESS rL f�� es` e CROSS ST.
LOCALITY / 7—y DISTRICT NO. Ready for Inspection PERMIT NO.
NEA V i / / s
CROSS BT. RREC7EIVED BY DATE ISSUED BY ATE
OWNERAIL
r �dAi/�I/,.� Al
ADDRESS USE LONE OCCUPANCY BK MAP PO
EL.NO. f/ �// Ar• ��
ONTRACTOR &--,3 Lp , 040ell CO.IMP.N0. ®3
ADDRES '/ ` JOB.N0.
, zo v �+sr jy TRUNK PERMIT NO.
REGISTRATION NO. COUNTY ROAD PERMIT N0. 2 gyp'D V/
LEGAL 7 �,r;4 r& STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT LJI � INDUSTRIAL
f-� ,� WASTE APPROVAL
SIZE OF LOT 9�� NOW ON LOTS q �_ CHARGES yam'
USE OF
BUILDINGS RJ �_ •. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT F`
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. I -DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLOG..OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
— ALTER OR REPAIR EXISTING NO- I DATE B1,11
SEWER OR DISPOSAL SYSTEM IAO
DISCONNECT AND-ABANDON SEWER - ti
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD 2A0 STATION DEPTH P
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00ENCE
Z;
'
A ..UPP.. rl ' ER
TY71 OF CONNECT LENGTH FROM e�
OWNERS PERMIT $ 1 " ap Y` CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED,
CONTRACTOR TO 'CONNEpT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P-UgiIC SEWER
SIGNED THIS_.•=DAY OFA 1 NEW HOUSE SEWER It-w- A-1 �L
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT .: �.._.•S'L.. _. ...__./.�.,_�.
BUILDING OR WORK
-ADDRESS-1-3 .. '._ 7_ �?'.Y .' AND/OR DRAINFIELD IT(8)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL- CESSPOOL[3 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS SQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIF O IA OR THAT 1 AM THE AL OWN- ABANDON HOUSE SEWER
ER OF THE AB VE D RIBS SID AL P P RTY. BACKFILL SEPTIC TANKS
SIGMA SEEP.PIT(S)0 CESSPOOLS
TURE
OF PERMITTEE
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