HomeMy Public PortalAbout4845 RIO HONDO AVE_Sewer__ DEPA"T OF'COUNTY!ENGnvLEEIIr SEWER., SEWAGE DISPOSAL
~� DIVISION OF BUILDING AND SAFETY �` PERMIT APPLICATION
COUNTY OF-.LOS ANGELES DUILDING
WILLIAM-J. 'FOX.. COUNTY ENGINEER CE �
- � I ADDRESS
r�-FOR APPLICANT fT`O FILL IN- r LOCALITYNEAREST
ADDRESS Y� CROSS$T. r l ; [..t.//.9w ._ .A,4DING
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LOCALITY ii L "�' �: DISTRICT NO. SERIAL NO. V PERMIT NO. c
CROSS ST.
NEAREST rY� � » � /`7/� 1 /� -22- r L7 5*/2 �/ ��_�0 S
� RECEIVED BY' Ready Tor Inspection DATE ISSUED
OWNER �i/ f- l�I�/J �: ��5)
MAIL USE
E Z/ONE I OCCUPANCY
ADDRESS
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hCITY D ^EL.NO47
CONTRACTOR r BK IIFAP
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CO.IMP.NO.
ADDRESS l JOB N0.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. ® COUNTY(' ROAD PERMIT NO.
LEGAL i DESCRIPTION LOT N0. STATE ENCROACHMENT�j)/) , PERMIT NO.
BLOCK TRACT S a4-( WASTE APPROVAL
SIZE OF LOTqNOW ON LOTS CHARG
USE OF
BUILDINGS 2ew) CONNECTION CHARGE EE
NO. DESCRIPTION OF WORK FEE } REIMBURSEMENT P16E
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 8.50 RECEIPT NO - I DATE I 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 NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 }�
-DISCONNECT AND ABANDON SEWER
ACONNECTION DATA i
ND/OR DISPOSAL SYSTEM I.00
SEPTIC TANK,SEEPAGE PIT OR
_PITS AND/ DRAINFIELD 2:00. �• STATION DEPTH
CESSPOOL—DRYWELL _ �1 '
SPECIAL CONDITIONS ONLY 2.00 i• MANHOLE REFERENCE
i UPPER LOWER
TYPE OF CONNECTION LENGTH FRdM
Y. CURB P.L._ M.L.TO P.L.
OWNERS PERMIT 1 00'� ,
AUTHORIZATION TOTAL FEE I 0�
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_—__..DAY OF_.._.�_—N_ _.19_.._x' NEW HOUSE SEWER
OWNER OR i CONNECT ADDITIONAL �
OWNERS AGENT'...:.._.._._..._......___.....____.. .._.. ._. i BUILDING OR WORK
_.__� 1 _
ADDRESS..._.....�.._.._. ' �.i SEPTIC TANK.SEEP.PIT(S)
_.._.._.._.._.._....-.-..w.—.------.. AND/OR DRAINFIELD
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
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 ABOVE DESCRIBED SIDENTIA PROPERTY = BACKFILL SEPTIC TANKS]
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OFSEEP.PIT(S)] CESSPOOLS]
SIGNATURE
PERMITTE 111 __......:._.�:2;
76A642A 683 7/53