HomeMy Public PortalAbout5837-5837 1/4-5839 1/4-5839 1/2 PRIMROSE AVE_Sewer__ DEPAUTMTENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, C17UNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FJLL INS LOCALITY
ADDRENG j' NEAREST
CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ' ✓. +1 ;rs
_ s "�+
MAIL --
_ADDRESS 'a r ; USE ZONE OCCUPANCY ( MAP
BK PG
CITY r > TE .NO. i
CONTRACTOR s?
- 1 ii=mss 4. CO.IMP.NO.
ADDRESS JOB N0. - --
CITY .r�-y -�-R—yt - TEL.NO.' d ,0
x [.fi TRUNK PERMIT N0. -----�--- -
ATE
REGISTRATION NO.14 , /7 t_. 10 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. Z- y STATE ENCROACHMENT
,.' PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE GF LOT ,� N0.8F BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO.I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 '� RECEIPT NO. DATE BY
HOUSE SEWER CORNECTI_NG TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT AODIfIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER 8R REPAIR EXISTING NO. DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND A8AND0N SEWER
AND/OR DISPOSALSYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTIONLENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT I 00
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC *EWER APPROVALS INSPECTOR'S SIGNATURE DATE
-^,
SIGNED THIS__,/_l......... ,
. 'OF F` .._.. ..... NEW HOUSE SEWER
I s
OWNER OR Iq CONECT BUNLDING OR WORK OWNERS AGEN i.. 1i >_ -.
i % ' SEPTIC TANK,SEEP.PIT(S)
ADDRESS T�1_ t _.-. y ".; _. _._ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT'1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL I
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE I
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
AND/OR LICENSED AS REQUIRED BY-LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA ORvz.z_�
THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBEDIAL PROPERTY. BACKFILL SEPTIC TANKS E�
w SEEP.PIT(S)E� CESSPOOLS❑
SIGNATURE /y
OF PERMITTEE-¢` "-i ' ..................
76A642D 663 1/53 .171,-d