HomeMy Public PortalAbout9134 PRIMROSE AVE_Sewer_9/16/1954_34155S connect additional bldg on to house sewer DEPARTMENT OF COUNTY ENGIIgE= SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER
�' 'I ADDRESS
FO APPLICA TO FILL IN LocaLlTr ��
BUILDING / s� ,g NEAREST
ADDRESS / ,% p/IdD /1 �/¢L CROSS ST. -
LOCALITY DISTRICT.NO. SERIAL NO. a,/PERMIT N0. c
NEAREST �J V` �� J
CROSS ST.
- R CEIqVED B� Rsady for Inspection QDATE I/SSUED
OWNERMAIL ,� / s� C%� r • +/�2 `S�
ADDRESS L.�Q `�JOD USE ZONE OCCUPANCY B
K Pa
CITY -r,,te A. TEL.NO.
CONTRACTOR ,
CO.IMP.N0. e'
ADDRESS 1'360 . ) JOB.N0. -y
1
CITY Q TEL' 4
.NyO. "°-X y7/ TRUNK PERMIT N0. -
7 STATE
®O/ ;
REGISTRATION N0. Jj i ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. �� �� STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT ���� i INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT �aX NOW ON LOTS CHARGES
USE
BUILDINGS I CONNECTION CHARGE\FEE
NO. DESCRIPTION OF WORK E' REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER Q $ 3.80 RECEIPT NO. I DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
WORK TO HOUSE SEWER LDC.OR 1.00 EXCEPTIO CORDED
ALTER OR REPAIR EXISTING NO* I TE IBY
SEWER OR DISPOSAL SYSTEM 1.00
_
AND
/OR DISPOSAL CT AND SYSTEM SEWER 1,00 CONN-.eCTIONNQATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE
UPPER REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS 1 PERMIT I 00 Y. CURB J•.L. -M.L.TO P.L.
AUTHORIZATION TOTAL FEE k•0-0 ''�'""""�
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INS PEC QR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER /►
SIGNED THIS.�. • _DAY OF. �_19�..
��o
� o CONNECT ADDITIONALOWNNERS AGENT / BUILDING OR WORK
/v' SEPTIC TANK,SEEP.PIT(8)
ADDRESS...-.._ —------ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS'-APPLI- CESSPOOL[] DRYWELL
CATION AND STATE THAT/rHE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL C UNTY ORDINANCES' D STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBIN A SEWE S SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIF T 1 PR E Y R ISTERED
AND/OR LICENSED UI N COUNTY DISCONNECT PLUG AND
AND STATE OFC A T AL OWN. ABANDON HOUSESEWER .
ER OF THE ABO 1 R A E JlACKFILLSEPTIC TANKS'[]
SIGNATURE
EEP.PIT(S)IJ CESSPOOLS.[]
_
OF PERMITTEE ... .._ - - . ._.. ......_ ..- . -. _••- =
7csna9s A.A x/64 . .