HomeMy Public PortalAbout5103 SANTA ANITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-.SEWAGE DISPOSAL.
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING _
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
AD REBUILDISS (,_I 0 3 NG J NEAREST
--�'- CROSS ST.
LOCALITY DISTRICT NO. SERIAL N0. PERMIT NO.
NEAREST A .��'' 3
CROSS ST. 14 RECEIVED BY I Ready for Inspection DATE ISSUED
OWNER w�I
MAIL }� j h �� U8E 2QE OCCUPANCY Bye ffi7AP PG
ADDRESS / hj- .E,L _
CITY `" J TELAO.
CONTRACTOR 'O L .' CO.IMP,NO.
ADDRESS JOB NO
CITY t"�w 4EL.NO. ��� �� L)" TRUNK PERMIT NO. t s y c
REGISTRATION NO. f J N fY r'
t,.. ( ,.�� �- ROAD PERMIT NO.
LEGAL i ! STATE ENCROACHMENT
DESCRIPTION LOT N0. / � PERMIT NO. --
BLOCK TRACT Lr INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT ( q "_�d NO BLDGS. C)
'
? NOW ON LOT
O F/ CHARGES
USE OF
a
BUIL INGS6' ,, CONNECTION CHARGE FEE
NO. DESCRIPTION OF dRK FEE
REIMBURSEMENT FEE --- -- -"`"-`-'•--'-�-
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO -r i-
_ PRIVATE DISPOSAL SYSTEM 1.00 - r
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
NO. I
ALTER OR REPAIR EXISTING DATE I BY
_SEWER OR DISPOSAL SYSTEM 1.00 - -
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEP IC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION -t DEPTH
— CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.001 MANHOLE REFERENCE
`j -tx�gJbg LOWER
OWNERS PERMIT $ 1 ).. 00
AUTHORIZATION I TOTAL FEE I
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED 1110 , DE
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING I R�81 TE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.......`............DAY OF__...._ .......................14 NEW HOUSE SEWER
OWNER OR CON
OWNERS AGENT f... 'i :.
( SEPTIC TANK,SEEP.PIT(S)
ADDRESS 1AND/ORDRAINFIELD
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
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 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)FCESSPOOLS0 �-k
SIGNATURE
OF PERMITTEE_.-_..._.----- ..... .
76A642A 663 7/53 r /J- /