HomeMy Public PortalAbout6339 SALTER AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL _ 1
::ov"DIVISYON OF BUILDING ANII SAFETY PERMIT APPLICATION
COUNTY OF LOSS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS 3 `/']'
3 , Jj A., C
R'APPLIT'TO 6FILL IN
LOCALITY ��
BUILDING NEAREST
ADDRESS" -twd. ° CR038 ST.
.LOCALITY � c� DISTRICT NO: V SERIAL NO. PERMIT NO.
ry
NEAREST A / d s
CROSS ST.
EVEDBY Ready for Inspection DATEISSUED
OWNER
AAIL
DDRESS�3�p.�- ti/dti. - USE ZONE OC UPANCY BK MAP PS s+
CIT z-A-c L - TEL.NO.�e�. ay " ", ( U
y � r
CONTRACTOR �� s yt}+ 1.r.r. +_t3A—
ADDRESS
.�J h CO.IMP.NO. l ��]� S
ADDRESS . r��.1i� .� ,�dt� °:'-/f
70B N0.
CITY / TEL.NO. / f J TRUNK PERMIT NO.
r STATE,
REGISTRATION N0. / Q e� � COUNTY ROAD PERMIT M0.
LEGAL Al jr.F AF.$'1149'x- STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT N0.
TRACT ,� `' 3 7 WASTE APPROVAL ___-------
A SIZE OF LOT S N0.OF BL
NOW ON LOT
CHARGES
USE OF ��' CONNECTION CHAR FEE
BUILDINGS 7JsG.7. •'4 1</� ��.I rG.P' _ �r
NO. DESCRIPTION OF- IIgK FEE �%
PHOUSE SEWER CONNECT N TO REIMBURSEMENT FEE
UBLICSEWER f 3.50 �� RECEIPT NO. I i/-(1TE� I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDS.OR ° E_XCEPTION RECOR'OED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING �No- I DATE
SEWER OR DISPOSAL SYSTEM 1.00
:DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT ORt._. /
PITS AND/OR DRAINFIELD 2.00 STATION L 7L J (V. r DEPTH (�
CESSPOO L—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 // / MANHOLE REFERENCE
P✓ . jj a% UPPER t
TYPE OF CTION LENGTH FROM /
OWNERS PERMIT $ 1 CD uRB >� M.L.TO P.L. /.r
AUTHORIZATION TOTAL FEE LL s' p
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE E80VE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO T 1'L BLIC SEW
SIGNED THIS. _.D F.-..-- 19 NEW NOOSE SEWER f •u ._, � �Z
OWNER ORff CONNECT ADDITIONAL
OWNERS A ENT.. 14_._ .BUILDING OR WORK
EPTIC TANKSEEP.
ADDRESS ,213 x. _. fl .: ...... AND/OR DR .AINF ELD IT(8)
1 .HEREBY ACKNOWLEDGE THAT 1 HAVE.READ THIS APPLI- CESSPOOL E) DRYWELL❑
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
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED DISCONNECT PLUG AND .
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA.OR THAT 1 AM THE.LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIALvPROP.ERTY. BACKFILL SEPTIC TANKS[] , '
SEEP.PIT(_S) CESSPOOLSID �a
SOF PERMITTEE,^,��1.�.y! � �.;gig✓! J i,._��"�i
TOAS42D 663 1153