HomeMy Public PortalAbout6602 OAK AVE_Sewer__ * DEPAICTNI ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOj-A.•PLICANL O 5L't IN LOCALITY
BUILDING y NEAREST
ADDRESS _ CROSS ST.
LOCALITYF /s"1`• DISTRICT NO. SERIAL NO. PERMIT NO. C
NEAREST A
CROSS ST: S
` �` —
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE f OCCUPANCY BK MAP PG
CIT}• ,' •' TEL.NO.
CONTRACTOR
— CO.IMP.NO.
ADDRE
!OB N0.
LITS EL.NO. d
TRUNK PERMIT NO.
TATE
REGISTRATION N0. Cl dj COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. /T STATE ENCROACHMENT
PERMIT N0,
BLOCK TRACT ° INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT T y NO.OF BLDGS. t
,+' NOW ON LOT / CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 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 N0, DATE i BY
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 DRAINFIELD 2.00 STATION rp� e DEPTH
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
LIPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 DO Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTPACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE. ESCRIBED EXISTING
DWELLING TO THEPUBLICSEWER APPROVALS INSPECTOR'S SIGNATURE DATE
, r� f
SIGNED THIS...!'_ ...DAY OF..--.14 110- �...........19'�-3 NEW HOUSE SEWER
//,t CONNECT ADDITIONAL
OWNERS OWNER ORENrT�"° p� ` Pq'�''s4e/. �rO c f...... BUILDING OR WORK
ADDRESS... 4--'v-. ..... e _ -9=^° SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
CAITHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL E]
ION 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA ORT 3 I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVEJX�SCRIBEDRESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKSE�
SIGNATURE
y SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE .: '--. 4 . 0$01a.r-� - I I
76A642D 663 1/53
7ZA642D - .-. APPLICATION FOR PERMIT - 1
6 d E-663 t2.54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles rA=DDRESSkr._13
VJNI.J.FOX, COUNTY ENGIN&HR CASSATT D.6RIFFtN.$uP•T OF BUILC53iG OCALITY i
FOR APPLICANT TO FILL IN CNEAREST
ROSSST.
LEGAL ,,.s
DESCRIPTION LOT NO. OWN
a •d,3 ') ER .
BLOCK _ TRACT ° ,$j1dAILd i
ADDRESS 1
NO. OF BLDGS.
SIZE OF.LOT; := p NOW ON LO7 aJ�.^ CIT - TEL. N0.
USE OF
BUILDINGS •�- w ��„ --
-- _ DISTRICT N0. � GROUP � MAPPG
CONTRACTOR( BK....
I
_ :� I
ADDRESS .o > • ,-..C._.,. .' 'i. CONNECTION DATA
�r p
CITY fSTAT10PRE DEPTH
❑ STATE MANHOLE REFERENCE
REGISTRATION NO. ,✓g ❑ COUNTY UPPER LOWER._-
TYPE OF CONN ION LENGTH F 0'�I
No. DESCRIPTION OF WORK FEE .� CURB L. M.L.TvP�L.
HOUSE SEWER CONNECTING TO
I
PUBLIC SEWER fZ� $ 3.50 1 �,----- --
HOUSE SEWER CONNECTING TO (( I
PRIVATE D SPOSALYSTE_M .1.00
CONNECT ADCiTlONFI BLDG. OR _ - `+ . I
WORK,TO HOJSE SEWER
1.00 CO. IMP. NO. / SOB. N0.
LTLR OR REP R EXIS9ING ✓� `
SEVER ORLMSPOSAL SYSTEM 1 CO. �. TRUNK PERM IYtiO. ROAD PERMIT NO'
DISCONNECT ANJ ABANDON SEVV ER T---- �
AND/OR DISPOSAL YSIEM STATE rNOCROACHMEY7
---- .'f'N
SEPTIC TANK SEEP °ERM SEEPAGE OR � I
PIS' AND/OR DRAINF_FLD 2 C0 ? JSTRIAL Y
'--- 14 A9;iEaLPROVAL .
T CESSPOOLDRTWELL '' -- -- — -=-
�_SPECIAL COND[T1Old$ONLY 2.00_I i� CHARGES
PERMIT — _ --I ! - CONNECTION CHARGE FEE._..� � �
OWNER'S'S _ I 00 � --
AUTHORIZATION —TOTAL FEL M1 j : REI MBURSEMENIZMEL
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- _ APPROVALS - DA7E 1N5 ECTOR�S5 TURF
1'RA TOR TO �GNNECT ('HE ABOVE i)ESCR dE°S f:XI_TING DWELLING
TO THE PUBLIC SEW;R
f / NEW HOUSE SEWER
SIGNED THIS Dry)^OF �. � -,V 195
OWNER OR CONNECT ADDITIONAL
OWNERS AG ,NTx BUILDING CR WORK
cy
SEPTIC TANK, SEEP, PITS)
P,ND/O fi DRAiNI IELD
I HEREBY ACKNOWLEDGE THAT t HAVE READ THIS APPLICATION CESSPOOL El DRYWELL(J
AND SPATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR --
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AIA PROPERLY REGISTERED AND/OR -----""'-___ -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE A9ANDQN HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) (] CESSPOOLS Q
St6NATURE
OF PEi2PatITTEEs£=y -; v--s
WILLIAM J.FOX,COUNTY EriGINEF..a VALI ATION
0 6 9 E- FSB V3 2.0
I3Y BY x..
DEPUTY t�.; ra- r�• DEPUTY
BY BY �*'-1
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