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HomeMy Public PortalAbout5750 PRIMROSE AVE_Sewer__ „,.:„AEPAlLTfdENT OF COUNTY ENGINE= SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING `` . WILLIAM J. FOX, MOUNTY ENGINEER I pTDRES$ 4 r j t4i �y�f• FOR APPLICANT TO F)4- IN LOCALITY ,k BUILDING NEAREST ADDRESS „) //► "/t��J,x. -�r�' CROSS ST. yt, i' - � "'�.,. •. __j'; y-' DISTRICT NO. SERIAL NO. 'PERMIT N0: LOCALITY c NEAREST A if S CROSS ST. Ecc IVED BY Reedy for Inspection DATE ISS ED j OWNER �- MAIL. USE ZONEOC UPANCY BK MAP PO ADDRESS � `-:'.s'•r,y L'-_� J CITY _ •a�r_�,.,�.•},1? TEL.NO. CONTRACTOR /F r {� �r I :�=- CO.IMP:NO. ADDRESS JOB N0. c`-'•� i TELAO. `=//•a.�.��%�r�Lftfi TRUNK PERMIT NO.. REGISTRATION NO. (�/ � COUNTY ROAD PERMIT N0.LEGA _• DESCRIPTION LOT NO. Sb ` SEAMIT NNCROACHMENT BLOCK TRACT Zi 07° -�� � INDUSTRIAL = WASTE APPROVAL SIZE OF LOT N0.OF B CHARGES NOW ON LOT No. USE OF BUILDINGS CONNECTION CHARGE.FEE N0. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO _ REIMBURSEMENT FEE PUBLIC SEWER a $ 5.50 RECEIPT NO. I DrrE I BY HOUSE SEWER CONNECTING'TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION ECORDED` WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. I DATE I BY _SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA f SEPTIC TANK,SEEPAGE PIT OR ..� PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00t q pb UPPERREFERENCE _b_b=913TYPE OF CON E TON LENGTH FROM OWNERS PERMIT ; I 00 cu RB .. M.L.TO P.L. AUTHORIZATION TOTAL'FEE — f2 I HAVE THIS DATE CONTRACTED WITH THE_HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS..s C..�..DAY NEW HOUSE SEWER �� �j�j Q c; OWNER OR r' = _i CONNECTADDI.TI'ONAL OWNERS AGENT. 2 � a... �l�:i''_u_.-.w:yg + _ ._r BUILDING OR WORK ADDRESS... ..... .._. SEPTIC TANK,SEEP.PIT(S) ....._......_..-....._-__..__�.....---.:..__.__._..__.....�- .AND/OR DRAINFIELD I.HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-PLI- CESSPOOL[] 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 AMD/OR' LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ON PLUGUSE AND AND STATE OF.CALIFORNIA OR THAT 1 AM THE.'LEGAL OWN- ER OF THE ABOVE DESCRIBED RE DENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0 r 01il SEEP.PIT(S)rl CESSPOOLS©_ .`ice ra �,<”-k" -- +�•� ;°, SOF PERMRTTE _A ..OL...... 76A642A 663 7/63 J� A 5 r."3'1 54 APPLICATION FOR PERMIT -DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer. County of Los Angeles 9S MING BUILD BU' SVM.J, FOX. COUNTY ENGINEER IDDRE 9, CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITYIg __ FOR APPLICANT To FILL IN NEAREST LEGAL ---- DESCRIPTION OPINES BLOCK TRACT MAIL"I ADDRESS NO.OF BLDGS. SIZE or LO ON LOT - i5 CITY TEL, NO. USE OF DISTRICT NO. I GROUP MAP BK PG CONTRACTOR 4L ADDRESS CONNECTION DATA -1,-y-No- T�EL, NO A 6 STATION DEPTH LI—STATE MANHOLE REFERENCE REGISTRATION NO. COUNTY UPPER LOW cR -Z TYPE OF CON14ECTION L E N L-T H FROM No, I DESCRIPTIW4 OF WORK FEE CURB TO_LPL HOUSE SEWER CONNECTING TO PUBLIC SEWER $ 3.50 HOUSE SEWER CONNECTIfir TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR CO. P,No. JOB, NO. 'WO RK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER I AND, ,0 'OR DISPOSAL SYSTEM I. 0 STATE ENCROACHMENT PERMIT NO. SEPTIC TANK,SEE PAC, `— F TS AND/CR 6RAINFIELD 2,00INDUSTRIAL , CESSPOOL- DRYWELL j APPROVAL P-'�(-.-i,AL,CCNl)!T!QNS.ONLY 2-00 CHARGES — CONNECTIONCHARGE FEE OWNER'S PERMIT $ I 1 � 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH IHE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING rVVELLING APPROVALS DIATE INSPECTOR S SIGNATURE 70 CHE PUBLIC SEWER 'I — SIGNED THI5_4DAY NEW HOUSE SEWrR OWNER OR CONNECT ADDITIONAL OWNERS A G EN T_ BUILDING WORK SEPTIC TANK,SEP, PITS) ADDRESS-__ AND/OR DRAINFiE�D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWrLL 0 AND STATE 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 f HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICE14SED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AV, THE LEGAL OWNER OF THE ABOVE --ABANDON HOUSE SEWER— DESCRIBED EWERDESCRIBED RESIDENTIAL PROPERTY. BACKFILL sEpriC TANKS El e SEEP. PITS) 0 CESSPOOLS[71 SIGNATURE OF PERMiTTEF c- F WILLIAM J. FOX, COUNTY 1fNGiNE:aR VALIDATION By 3 q y 3 01'rR APR 2 6 4 2.0 CN) DEPUTY DEPUTY BY By 0 DEPUTY __6EPUTY