HomeMy Public PortalAbout5723 PRIMROSE AVE_Sewer__ 'aAE APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer _
County of Los Angeles B
UILDING
�IlV M.J. FOX, COUNTY ENGINEER` -
CASSATT E1. GRIFFIN, SUPT Ofr BUILDING FOE APPLICANT TO FILL IN
r_3,"C ^CROSS,ST.
LEGAL a�T:_.:A,5 i ✓ ,� `_n ,�P --
DE`SCiIIPTION�-.LOT NO _s tsy .;_y�;�" OWNER ,'d . M �
BLOCK TRACT S MAIL ,F"` ! ;�+ y�,'^"
- 1 J-� i r
r A.DDRESS.�- NO.OF BLD45. 37'y -
SIZE OF LOOT- NOW ON LOT Y CITY fR TEL,N0.
USE OF A j- '�'/. IBM
BUtLDtiNGSfi y r t -'= € _ DISTRICT NO. GROUP }SAP
- -� ,1.•-yx, a � �' ,y' SK Ply
CONTRACTOR
ADDRESS ` CONNECTION DATA
CITY 1- --'. , J' TEL.NO r- - . -^' STATION - DEPTH C �.
[] STATE ri M4V_4,ELE-RF-.FERENCE
REGISTRATION NO. /fJ^'• - � `"r C:r-E6v"1:vY _" ._ r ._UPP_ER'..,r 41yr 'e"'K-
-'-- - ---- '` TYPE OF CONNECTI. N LENGIH FROM
No. DESCRIPTION OF WORK FEE �`. LuaB �./�P.L. h1.L rG P L,
HOUSE SEWER CONNECTING TO
PUBLIC SEWER _ rc $ 3.50 i-�J � d -- ---.�-•- - -
HOUSE SEWER CONNECTING TO
PRIVATED SPOSA SYSTEM 1.00 i - - -- - --------,�----- -
_--. _— _ _ .v -
CONNECT ADDITIONAL BLDG. OR
I CO. IMP.NO, _ SOB, NO.
W RK_TO HOUSE SEWER '1
-ATER OR REPAIR EXISTING—
_ 4WUP O I DI POSAL SYSTEM _ _ 7.00 { i TRUNK PERMIT P70 " ,ROAD PERMIT NO
D CONNE ABANDON BANDON SEWER- j - i '.TATE ENCROACHMENT
F?..i,R O(S✓•�SA��YSTE 11 1.00
---' PER Mi IT NO.
S1PI`iC TANK. SEEPAGE PIT OR
—
PI[S ANDIOR DRAINFIELD2.06 INDUSTRIAL
C!_S..f'f7UL- DRY1Q tLI.-�- WASTE APPROVAL
-__PC1AL CONDiTIONS_ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
®�� PERMIT 1 ( DO - ----�_ - ---� —
REIMBURSEMENT FEE
AUTHORIZATION 1--T—OT-AT, rEE 1i
I HAVE THIS DATE CONTRACTED WITH TH7 HEREIN NAMED CON-
"RAC TOR TO CONNECT THE ABOVE DESCRIBED EXISTINGD✓ELLING
TO THE PUBLIC SEWER - -- -- -- - ----- -- -------
J NEW HOUSE SEWER
SIGNED THIS DAY CF - .--- -t5 -----
OWNER OR J,'- ', CONNECT ADDITIONAL
G':VMERS AGENT - y��-j' ,... a._ .�y(..,�. _ _BUILDING OR Y4 ORK
SEPTIC TANK, SEEP PITS)
A iDhERFBY ACKNOWLEDGE e --�-� � g AND�OP DRAiNFIe O_
YLEDGE THAT 1 H,vv'_�It'L�IF4rI" 1S N. �1!lOIJ CESSPOOL 0 DRYVgrL.L C1
AND STATE THAT HE ABOVE IS CORRECT ANDVAGREE TO COMPLY
W17H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR.SEWER OR
PLUMBING .AND SEWERS..
SEWAGE DISPOSAL S"37EM
4 E E+E.BY CERTIFY THAT I AM PROPERLY REGISTERED ANWOR
L1C N5 D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CA.I IFOR'I TA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL FROPERIY. BACKFILL SEPTIC TANKS[]
SEEP_. PIT(S) CE.'&SPOOLS
SIGNATURE
OF PERMITTEE- -
WILLIAM J.FOX, dOUNTY ENGINEER
VALIDATION
BY
DEPUTY --, .". DEPUTY'..:
BY BY
a�} DEPUTY DEPUTY