HomeMy Public PortalAbout5203 SANTA ANITA AVE_Sewer__ 4 w..
7SA6420
E-663; APPLgCATION FOR PERMIT" z �� � ,• ..
$& -88 �K36 '
,VIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING ,
VVIR(.J. FOX, COUNTY ENGINEER ADDRESS OX, t_
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY y'
_ C
FOR APPLICANT TO FILL: IN ROS r
CROs ST E
LEGAL - - s .�--
DESCRIPT[ON LGT NO. OWNER -
BLOCK TRACT - MAIL
NO. OF BLDGS.
SIZE OF LO_7 _ NOW_ON LOT ,.t�, CITY TEL. NO.
USE OF
BUi1DINGS_ — _ DISTRICT NO. ,± GROUP MAP
BK PG
CONTRACTOR, '��,.
CONNECTION DATA
xx
ADDRESS .y -'2 _ J c. t C_F.(. ,i._ yf
TEL. NO.#r.>+��. ✓ r ,� d1 STATION - - DEPTH
.UPPER..-
"TATE MANHOLE REFERENCE �sVuE_
REGISTRATION NO. / ;i '' Q COUNTY
NOJa DESCRIPTION OF WORK FEE — -- -
----� - — - -- - � TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNF,rTiNG TO Y. CURB_^ P_L. _M_L. TO
PUBLIC St4dER @u $ 3.50,__ _�•' -- - -
�+ HOUSE SEWER CONNECTING TO -
�� PRIVATE DISPOSAL SYSTEM I.0_0��_:_ .------- -- P C. NO.
CONNECT ADDITIONAL BLDG. OR -
_^ ! NQRK_TO HOUSE SEWER _f._00� CD ._ 4-� _.lt B No . +�-lp� --_�
AI TER OR REPAIR tXF571NG -
SE[V R OR DISPOSAL SYSTEM t.00 1 TRUNK PERMIT NO PERMi-
(
AND/OR
ND-ISCODISPOSAL.
IS DtSO BA I' N A^tACOSEWER
AND
�! /Ok POaA[ 5 fSTr<fi_ f_00:' PFATE �':_
SEPTIC TANK, EcPA E PIT OR -
PITS_AND/OR URAINFIELD _2_._0_0
CESSPOOL DRY'/ LL WA iii `VAL
SPECIAL CONDITIONS ONLY 2.00
-. £R ,i, J CHA1?GE FEE
AUTHORIZATION --TOTAL S. REIMBUPSE LENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NA14ED CON-
TRACTOR
ON-TRA TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATENSP,CTGR'S SIGNATURE I
TO THE PUBLIC '--'-SEWER - -- --- .�-'-- -`---�
SIGNED THIS I, »r—DsAY Q� 19�.=_ —NEW HOUSE SE;dER mf�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ' .✓ r�':. ' BUILDING OR WORK
SEPTIC TA tFK, SEEP, PIT(S)
AND/OR DRAINFIELD 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CZSSPOOLD. DRYWELL❑ d
AND 'T
STATE THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY
-WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTE_h1
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAG NDIS DISPOSAL
AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFPLUG
CALIFORNIA OR THAT I 4M THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DE5CRiISED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[; J
v ---- SEEP.PIT(S) L3 CESSPOOLS 0
SIGNATURE -21-
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALdDATION R.A.WOOD.C#iIEF PLUG. INSPECTOR
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