HomeMy Public PortalAbout6279 PRIMROSE AVE_Sewer__ DEPARTIIUNT OF COUNTY ExanvE3M SEWER—SEWAGE DISPOSAL' 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COIINTY OF LOS "GICE ES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS ` �� �.P��iC'��5�'J,"dz
Cia a �Y-
FOR APPLICANTITO FILL IN -CALITY
BUILDING l NEAREST
ADDRESS LQ 2_7� - )f1' r��� � CROSS ST.
LOCALITY/ ! DISTRICT N0. SERIAL N0. PERMIT N0.
GROSS ST . a r � .��'; eoe E-em ' `' ' A 2�, S
�/j� ,q REC ME D gY Ready for Inspection OATE ISSUED
OWNER cfT V I II. (' /l _ 1 �J:. .L'f Q�}=rl.`"I..: J �% �'�: /
AMAIL , GOCCUPANCY
.DDRESS _r4 , USE ZON� 100,
�y ,� ,/ �c
CITY _ � TEL.NO. �� P .�t � % � s �f 33
CONTRACTOR
ADDRESSI /A• ,✓ C_% n -LtelI:-' E+<r . . .�
,,� Lf'r off JOB.N0:
CITY TEL.NO: � s� TRUNK PERMIT N0. �•—�
REGISTRATION NO. ® COUNTY ROAD PERMIT NO. ,2 ;761 DIJ
LEGAL 32 G 26 Y S2� STATE ENCROACHMENT
DESCRIPTION LO NO. X. N/ J%S//OGdIT/
PERMIT N0.
BLOCK r/! TRACT "`�" '� ''°`' INDUSTRIAL"
v WASTE APPROVAL
SIZE OF LOT { _>" NO.OF BLDGS.
,J /.�=Lf NOW ON LOT - CHARGES
USEO
BUILDINGS (t'} s CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
' REIMBURSEMENT FEE
PHOUSE SEWER CONNECTING TO c_ 121,
U13LICSEWER 5 3.50 �� liT RECEIPT NO. i TE BY
' HOUSE SEWER CONNECTING TO -9,<7 I
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXC TION R CORDED U
WORK TO HOUSE SEWER._ 1.00 .
ALTER OR REPAIR EXISTING' NO. 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 STATIONQ��� DEPTH 7 Z
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.001
MANHOLENREFERENCE LOWER
YPE OF CONNECTION LENGTH FROM P
Y.
OWNERS PERMIT ; I pp CURBM.L.TO P.L.
tPNxx
AUTHORIZATION I TOTAL FEE
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 '{,
1 NEW HOUSE SEWER
SIGNED THIS_. DAY OF ✓ = ► _19 " 4 .o-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_.. . �. /!.___ "' BUILDING OR WORK
--.�.
� J' SEPTIC TANK,SEEP.PIT(S)-
ADORERS _...... __ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE.READ THIS APPLI- CESSPOOL[] DRYWELL11
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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
ND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE.SEWER
ASTATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- .
ER OF THE .B j%E DESCRIBED RESIDENTI PROPE&TY7 BACKFILL SEPTIC TANKS
SIGNATUR vi �. Ll W. SEEP.PIT(S)[] CESSPOOLS O.
OFOF PERM1 "
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