HomeMy Public PortalAbout4853 RIO HONDO AVE_Sewer__ DEPAUTIVIENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS 7 �Y. � 1 �/�Al
FOR APPLICANT TO FILL IN LOCALITY -7' rm%ov/�" el r...,
ADDRESS 1-BUILDING -- / , /9 /�� ��G����C��j�f��= CROSS ST. L ���� ��C��•/� le
LOCALITY /I✓'r�/ � DISTRICT N0. oSERIAL NO. PERMIT N0.
NEAREST / �� C) S
CROSS ST. Gl� RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
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CITY + _ TEL.NO.
CONTRACTOR 0ALS
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CITY L.z., . �L TEL.NO. "- j("'Ife L
STATE
REGISTRATION NO. r SC? COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. /Y✓ SOX�/E/45r tE 3•��1 STAT'E"ENCROACHMENT "
z PERMIT NO.
BLOCK TRACTRIAL.
AU APPRO.V,AL. ..__,
SIZE OF LOT j X NOW ON LOTS CHARGES
USE OF
BUILDINGS f Af'S /, fJ/ - CONNECT CHARGE FEE
NO.! DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSE EN7 FfiE
PUBLIC SEWER @ $ 3.50 RECEIPT O. "....1f/T I BY
HOUSE SEWER CONNECTING TO r''{
_PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR `EXCEPTION REC !K
___WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATE
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 2.00MANN REFERENCE
-: � LOWER
TYPE OF CONNECTi, LENGTH FROM
OWNERS PERMIT ; 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION 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 ..............19-_'2__ NEW HOUSE SEWER
- CONNECT ADDITIONAL
OWNER ORs iy i y BUILDING OR WORK
OWNERS AGE PI -- s ?�:....._,- =-•-
"' nli SEPTIC TANK,SEEP.PIT(S)
ADDRESS-.-- --. ..- _-. J' "4:_ t.,�i.F � -._� ----... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL I]
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
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 DESCRIBED RESID NT PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE SEEP.PIT(S)o CESSPOOLS
OF PERMITTE --l- ��.- e. 4 Lam`
76A642D 663 1/53 -