HomeMy Public PortalAbout6658 OAK AVE_Sewer__ 'iGA -56
E-6fi�3.5,>. APPLIC ATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWERS--SEWAGE DISPOSAL �■1
Department of County Engineer
County of Los Angeles BUILDING ;.
WM.J. FOX, COUNTY ENGINEER --ADDRESS
CASSATT D.GRIFFIN,SUPT OP BUILDING °-�-,
p� LOCALITY � '�&� 6r,� f
_
FOR APPLICANT TO FILL IN NEAREST
NCROSS STS -
LEGAL ;f` p
IIE5CRIPTION LOT NO. _: _ _O'WNER T'�. � '��: . /
BLOCKj TRACT 1' MAIL
---- -------" d � 1�jjl", d-rvr.. ADDRESS_ - CA• ,..:
NO OP 66LDGS'r'i'
S72.E OF LOT - —NOW ON LOT' CITY' _ ._ .� TEL. NO. kgoL97 pi
USE D � ,�� .
B IiILDIN �,_ ^_r �+ � ..� DISTRICT NO. GROUP i MAP
8K PG
CONTRACTORN..s •_
ADDRESS CONNECTION DATA
CITYAEPTH
TEL. NO. STATION .f
- , ,t-' r ' . ,.
i`:v 3'
,u STATE MANHOLE REFERENCE
y !" LOVJtR
REGISTRATION NdO ) �' }' e, d COUNTY
NO. DESCRIPTION OF WORK FEE
— TYPE(,Fy1CDNNECTiON LENGTH FROM --
HOUSE SEWER CONNECTING TO �— II v 7CUR6: P.L_ M.L. TO P.L.
PUBLIC SEWER 0 $ 3.50 _�. —
HOUSE SEWER CONNECTING TO
_— PRIVATE DISPOSAL.SYSTEM _ 1.00
J I CONNECT ADDITIONAL BLDG. OR P C N0.
YJORK 74 HOUSE 5 V 'R 1.00 a .O;_]P.1P, td0. _ —4 �_--JOB N0.—__--�
ALTER OR REPAIR EXTG ^— — - -- --
ISIN
___j SFWER OR DISPOSA SYSTEM _ 9.00 �'RUNK PERMIT NO. ROAD PERMIT NA.
DISCONNECT LAND ABANDON SLWiR
kNDi_OR—� D+S OSAL SYSTEM 1.40 `}TATE NCKOACHMENT
?cr'P41T NO-
� SEPTI
;,' TANK, SEEPAGE PST OR - —' ------------- --
_f P_7 AN OR DP. INFIELD .40 INDUSTRIAL
CESSPOOL-DRYNELL
WASTE APPROVAL
_LSPECIAL CONDITIONS ONLY 2.00 C;{ARGES
PERMIT �
CONNECTION CHARGE FEE
OWNERS $! 11 00 --�
AUTHORIZATIONTOTAL FEE REIMBURSEMENT FEE
I HAVZ THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST:NG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER —_ - -- ..-- ----- ---------.�---
3 NEW HOUSE SEWER
SIGNED THIS- v SAY
`NOF
OWN OR —.CONNECT ADDITIONAL
'�' y, ' ✓
OWNERS ABUILDING OR WORM,
�CEN7 .� .� v zo c r„f s' f'... ---- - ----- - ----
_ SEPTIC SEEP,
TANK, S t , PIT(S)
APTI .�.___..
SEC DP_.2(iJ E
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL.0 DRYWELLEEI
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY OP,DINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBENG AND SEWERS, SEWAGE DISPOSAL G STEM -
I HEREBY CERTIFY THAT I AM PROPERLY REG{S3E'1VED AND/OR —”- :L---_� '—
LICENSED AS REQUIRED BY LOS ANGELES COUNTY✓AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE I.E6AL OWN.ER OF THE AB VE ABANDON HOUSE SEWER
DESCRIBED RE.S{DENT{ PROPERTY '
BACKFILL SEPTIC TANKS[7, -
SEEP. PIT(5) Cj CESSPOOLS C]
SIGNATURE
OF PERMIT z•- ...
WILLIAM J.FOX,C Y ENGINEER ,% .VRLIDATION R.A.WOOD, CHIEF FLEIG. INSPECTOR