Loading...
HomeMy Public PortalAbout5927 PRIMROSE AVE_Sewer__ DEPARTMENT OF COUNTY ENGEM sSERVER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, C13UNTY ENGINEER BUILDING I ADDRESS 5 '7 FOR APPLICANT TO FILL IN = LOCALITY. BUILDING ��.g '/ NEAREST - ADDRESS m�Ce / /�` ✓,I�JJ?la9E.fO, CROSS ST. l.t LOCALITY . .7/P� y DISTRICT NO. SERIAL NO. PERMIT NO. c NEAREST �' �/ A 't (C_1 1 J CR088 ST.. l�p /,/ l/Pi - ' CEIVED BY Ready for Inspection DATEISSUED OWNER Dy �.®� �CI•Pr. �''d.�IJ MAIL ADDRESS ✓�_ '�� USE ZONE OCCUPANCY BK MAP PG CITY /1 TELNO. - 3 CONTRACTOR �M, CO.IMP.N0. ADDRESS ,yam JOB.N0. CITY— �� Y (� ��TELNO. ,��j � ' TRUNK PERMIT NO. TATE REGISTRATION NO. / �j�jQ ®COUNTY ROAD PERMIT NO. DESCRIPTION LOT NO. ��� STATE ENCROACHMENT PERMIT NO. BLOCK TRACT /r�� INDUSTRIAL WASTE APPROVAL SIZE OF LOT rO � NOW ON LOTS, CHARGES NO-OF BLDG USE D BUILDINGS INGS N CH EE CONNECTIO�PdF� ��� NO. DESCRIPTION OF WORK FEE 1 REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO �+ / PUBLICSEWER • G $ 5.50 RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDO.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1:110 ALTER OR REPAIR EXISTING NO',I DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 AND/OR DISPOSAL SYSTEM SEWER 1,00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD- 2.00 STATION �-}. ,� DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00MAREFERENCE { a LOWE TYPE OF CONNECTION--Z-s LENGTH FROM tom, P.L.2 M.L.TO P.L. OWNERS s . . 00 , AUTHORIZATION' l TOTAL FEE 'p.. 1 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-.2-9—DAY OF- e _ '19. � NEW HOUSE SEWER �C, a �_ d .S OWNER OR ��l /© ' CONNECT ADDITIONAL OWNERS AGENTGC�r�..l 1f fi ! BUILDING OR WORK AJ t/ SEPTIC TANK.SEEP.PIT(S) AND/OR GRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL E] DRYWELL 11 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 I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED' AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY; ABANDON HOPLUG AND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN= ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE �,, ` SEEP.PIT(S)E] CESSPOOLS C? B Ck OF PERMITTEE.4462. 7RAR42A RR3 7/53