HomeMy Public PortalAbout4919 RIO HONDO AVE_Sewer__ s "n -s,fscs s"ss n
s APPLICATIONAPPLICATIONFOROR PERMIT& s
DrVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Las Angeles BUILDING y 17 --
WM,J.FOX, COUNTY ENGINEER ADDRESS
CASSATT 0.GRIFFIN,SUPT OF BUILDING LOCALITY
f b' ✓; yv
let
- NEAREST M
FOR APPLICANT TO FILL IN _CROSS_$T,�
LEGAL
DESCRIPTION LOT No. µ z " a. t/' OWNER ;✓ °y aay.� �
,9
BLOCK TRACT 14AI L
_ADDRESS
NO. OF BLDGS. Y
512E QF LOT NOYW ON L07 CITY TEL. NO,
USE OF
BUILDINGS_ I - —_ DISTRICT NO. i GROUP MAP
8K PG
CONTRACTOR '".'.
_ADDRESS ri.�v" ",s `-Y .` , � >!,,.,.-�•� -0 --- CONNECTION DATA
'
CITY TEL.TEL. NO. dp'° � ..� '�€ STATION s i�. —DEPTH
MANHOLE REFERENCE U°PeR
REGISTRATION NO, [] COUNTY .--`_- _ ___ _._-.--.._____..-_._ _..---. L044ER,_.
---
NO.1 DESCRIPTION OF WORK FEE _._. --- --—=— ——------ --—
TYPE of CONNECTION E r _r lRTi'A
HOUSESEWER CONNECTING TO Y, .CURB P.L, h T o.L.
�—PUBLIC SEIVER r(l_.' $ 3.500 -.. ----___—_�_ .-...- -.--
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1._00; I—.._..,
CONNECT ADTITIQ�'AL BLDG.OR I I�� — P C N0.
WORK 'IO HOUSE_SLN « 1T00�-, { CO. IMu 10. JOB NO.
k LTEP. OR REPAIR EXISTING —`
SEW:R OR D' POSAL SYSTEM 1.00.��_� TRUNK PERMIT LA0, ROAD PERMIT LA0.
ISCQNvECI AND ABANDON SEWER STATE ENCROACHMENT c
_
AND/CR DISPOSAL SYS _E-M 1.00 P(:RIM,FT NO.
SEPTIC TANK,SEEPAGE Ptl OR --- -'- --" v-- - t
F TS AND/OR LRAINFIELD .CO INDUSTRIAL
CESSPOOL -DP.YWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY CHr,R.,ES
I
.- J I_--- --CONNECTIONCHARGE FEE ------------.------�--- f
PERMIT f €
AUTHORIZATION TOTAL FEE � REIMBURSLMENT FEF
.1L _
I HAVE 'THIS DATE CONTRACTED WITH THE HEREIN NAM D CON- APPROVALS�n
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELL]NG �-LJC'GIiO s�LS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER - 6
SIGNED THIS---DAY OF 19— NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL �.
OWNERS AGENT— �� -)i" -_ BUILDING OR WORK
--- _— -i-_-` — --� SEPTIC TANK,SEEP, PIT(S) - —
RNDi Cft DI'A7_N EL ELD yy
I HFREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONS �l
AND STATE THAT THE .ABOVE 15 CORRECT AND AGREE TO COMPLY CES_POOL[,� LRYVv cLL❑ _
WITH
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR 5-NER OR
LUt.18ING AND SEWERS. SEWAGE DISPOS.AL SYSTEM
IiERELY CERTIFY THAT I AM PROPERLY REGISTERED AICD/OR -- -'
=.LASED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
FORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
IBED RESIDENTIAL PROPERTY.
BACKFILL SEPTIC TANKS '
r e SEEP. PIT(S) C] CESSPOOLS[}
TURF
RMITTEF--4C I ,_'� �" - 1;v/ I
J.FOX,COUNTY ENGINEER VAMATION R.A.WOOD, CHIEF PL.BG. INSPEC-