HomeMy Public PortalAbout6042 RENO AVE_Sewer__ DEP"nmq*1` OF COUNTY ENGINEER
- _ -SAYER--SEd49AGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING �
ADDRESS l.7
FO APPLICANT O' FILL-N LOCALITY 77—�a
BUILDING (/ NEAREST
ADDRESS io 1 - '/i L�jyL•(S CROSS ST. _ �",Xj�°•'L?� �•-
LOCALITY fn�� DISTRICT NO. SERIAL NO. PERMIT NO.
r A -__ 23M
�S—S
CROSS 8T. REC VED!IY Ready for Inspection D T 188U D
OWNER , i
MAIL
ADDRESS USEZON67 OCCUPANCY
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CITYTE .NO. Ae- I sCONTRACTOR va°- CO.IMP.NO. ® .
ADDRESS D �— ��.. JOB NO. - -
CTY , sTELAO. TRUNK PERMIT NO. / /
REGISTR ION NO. (� ® COUNTY ROAD PERMIT NO. ZC�J �!J
LEGAL ° STATE ENCROACHMENT.
DESCRIPTION LOT NO r b PERMIT NO.
BLOCK TRACT ,/? °CFS WADTR AL
STEA PROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE
BUILDINGS i�_ CONNECTION CHARGE F
,
NO. DESCRIPTION OF WORK FEE`S
_ REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO �y
PUBLIC SEWER @ $ 8.60 .) ,Lj d RECEIPT N0. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD(.OR EXCEPTION R CORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I DAT I 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—D RYW E LL
SPECIAL CONDITIONS ONLY 2.00 /� �. //MA*UPPFrIFR FERENCE -LOWER_f
TY!PE 0 Mn/CTION-,_ LENGTH FROM
OWNERS PERMIT _; I 00 cuRB� -anile M.L.TO P.L. 5ef
AUTHORIZATION TOTAL FEE d
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 S
NEW.HOUSESEWER rk
SIGNED THIS----.-DAY OF_._____._..__...__`.19.._._. �C
OWNER OR �ryLc.�iu BUIIL INCONNECG OROWORKAL
OWNERS AGENT..._.._.._.�C- ....._.._ .__,._..__...._.._._.._.._._._ ,
_..___.._.._.._. SEPTIC TANK,SEEP.PIT(S)
ADDRESS...-----..... -•---•---.__.......__... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL,tj
CATION AND STATE THAT THE ABOVE 18 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
i
AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED NiSIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
ATUSEEP.PIT(S)E] CESSPOOLS
Se.
GO PERMITTEE. .._ _ _.....
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