HomeMy Public PortalAbout4859 RIO HONDO AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
4 COUNTY OF LOS ANGELES ffi �}
WILLIAM J. FOX, COUNTY ENGINEER i
ADDRESS A
ADDRESS
FOR APPLICANT TO FILL IN LocALlry
BUILDING d a 0'11v NEAREST ;y
ADDRESS � , _ .''_ im CROSS ST. �/E� D
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LOCALITY �' _ DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST J A � �/ S
CROSS ST. cif, r
RECEIVED BY Re�{►y-dor Inspection DATE ISSUED
OWNER , '� .-
MAIL
ADDRESS `L� 1'5 3A'f / BK PG
�t3sC d, USE ZONE OCCUPANCY J MAP
CITY TEL.NO. ,9 ✓'`f"i , r - !
CONTRACTOR - f - �q / � a
' CO.IMP.N0.
ADDRESS / 3 /U`I E, JOB NO. 4+'
CITY TEL.NO. .._/6i/`t -
� T�tlMfN'PiR1Y1fT' -t.
STATE +9
REGISTRATION NO. ,/ 3 � � COUNTY ROAD PERMIT NO. ir3 &a 2-
LEGAL
/
DESCRIPTION LOT NO. / G /CG` v STAT&-€-NCft0=RVE n"— --,
PERMIT NO.
BLOCK TRACT h INDµST#DFAt:--W - m
WASTE APPROVAL ✓
SIZE OF LOT ,�^' �6' N0.OF BLDGS.
7 L' =yi NOW ON LOT CH RGES
USE OF
BUILDINGS ,ft ' P e'le e C0NNECTT ARGE FEE
NO. DESCRIPTION OF WORK FEE
---'------ REIMBURSENTFEE
HOUSE SEWER CONNECTING TO M
_PUBLIC SEWER @ $ 3.50 RECEIPT 0. DATE ,, i BY
HOUSE SEWER CONNECTING TO f J
PRIVATE DISPOSAL SYSTEM 1.00 ttt
CONNECT ADDITIONAL BLDG.OR EXCEPTiRECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- ( DATE i BY
SEWER OR DISPOSAL SYSTEM l.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION ✓ DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 A511 MAN E EFERENCE
TYPE OF CONNECTION LENGTH FROM �71+y
OWNERS ; 1 00
}
Y. CURB P.L. M.L.TO P.L. L C:�
PERMIT
AUTHORIZATION I 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........ NEW HOUSE SEWER
OWNER OR9 ALL CONNECT ADDITIONAL
OWNERS AGE T_ i " .. n�' ' BUILDING OR WORK_
_ Iii; '`
ADDRESS L � {' _._. o^ SEPTIC TANK,SEEP.PIT(S)
-�f ..__ .r --(-.• .. .�_..__....._... AND/OR DRAINFIELD
I
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL
CATIONAND 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. GfSGRtBED ftESeNT^ PROPERTY. BACKFILL SEPTIC TANKS a
A SEEP.PIT(S)Q CESSPOOLS 0
SIGNATURE �,v''�' �
OF PERMiTTEE,8 f----- • .......
76A642D 663 1/53