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HomeMy Public PortalAbout5934-5934 1/4 5934 1/2 PRIMROSE AVE_Sewer__ DEPAKrI1IENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOC, COUNTY ENGINEER BUILDING I ADDRESS FOR APPLICANT TO FILL I LOCALITY BUILDING NEAREST ADDRESS 7 — CROSS ST. LOCALITY DISTRICT NO, SERIAL NO. PERMIT NO. NEAREST A J CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL r /� ADDRESS :3�` i USE ZONE OCCUPANCY MAP t � BK PG CITY TELAO. CONTRACTOR CO.IMP.NO. j ADDRESS S C I�,✓ A '?. e, r'G� a JOB NO. CITY: 2' TEL.NO. 6 TRUNK PERMIT NO. 1�_) RATE REGISTRATION NO. '4n„vOUNTY ROAD PERMIT NO. LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. BLOCK TRACT INDUSTRIAL - WASTE APPROVAL SIZE OF LOT ,! NO.8F BLDGS. NQW ON LOTS CHARGES USE OF BUILDINGS ? r b-^- CONNECTION CHARGE FEE NO. DESCRIPTION OF WOR14 FEE OUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLICS WER $ 3_50 RECEIPT NO. I DATE 1 BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING N® I DATE BY SEWER OR DISPOSAL SYSTEM_ 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 GO Y. CURB P.L. M.L.TO P.L. AUTHORIZATION I TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE SIGNED THIS____-. .DAY OF ? Iqt ._ NEW HOUSE SEWER OWNER OR ° CONNECT ADDITIONAL OWNERS AGENT {4_� BUILDING OR WORK _ SEPTIC TANKSEEP.PIT(S)-ADDRESS a__ f AND/OR DRA.NFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL© DRYWELL 0 CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR 1 REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE y_lCzj& RESIDENTIAL OPE BACKFILL SEPTIC TANKS(� SIGNATURE SEEP.PIT(S)� CESSPOOLS OF PERMITTEE.-..------ _.._.. ------- 76A642D 663 1/53