HomeMy Public PortalAbout5227 SANTA ANITA AVE_Sewer__ DEPARTIVIENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS AlNT GELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUPT OF BUILDING ADDRESS � :f Y
FOR APPLICANT TO-.FILL IN LocaurY 7_'vj."A 14
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BUILDING NEAREST i �
ADDRESS -.: .9 !k`' k" CROSS ST. a�
LOCALITXDISTRICT NO. SERIAL NO. PERMIT NO.
> .(= _ AS
NEAREST
CROSS ST � +, RECEIVEDBY Ready for Inspection DATE ISSUED
IV
OWNERMAIL '
ADDRESS r USEZONE OCCUPANCY MAP
BK PG
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CITY dl� TEL.NO.
CONTRACTOR ya CHARGES REIMBURSEMENT FEE
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ADDRESS r REQUIRED
- --- NOT REQUIRED
CITY` TEL NO "^ a o a4 9J r - - -- CONNECTION CHARGE
JOB NO. - , ECEE F
REGISTRATION N0, ' f CSIATE
OUNTY CO.IMP.N0.
LEGAL RECEIPT NO. i DATE BY
1
DESCRIPTION LOT N0. b` ro -`
BLOCK TRACT -' r WAIVER FOR RECORDING
SIZE OF LNO*
O OF BLDGS.OT/� NOW ON LOT RECEIPT NO. DATE BY
USE OF
BUILDINGS TRUNK PERMIT NO.
N0.{ USE EW PTIONRCOWN OF WORK FEE - —� --HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
_ PUBLIC SEWER @ S 3.50
HOUSE SEWER CONNECTING TO — STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO. --
CONNECT ADDITIONAL.BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.400 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM _1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER -- `
AND/OR DISPOSAL SYSTEM 1.00 I STATION DEPTH `
z:
SEPTIC TANK,SEEPAGE PIF OR - ---
PITS AND_/OR DRAI_NFIE_LD 2.00 _ MANHOLE REFERENCE-
CESSPOOL-DRYWELL U l PER LOWER
SPECIAL CONDITIONS ONLY 2.00 I TYPE Of CONNECTION LENGTH FROM
i Y. CUF.B P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 1 00 — }
AUTHORIZATION TOTAL FEEIHAVE THIS DATE I
NAED
CONTRACTOR TO CONNECT THTE ABOVE p SCRIBEDWITH THEIEXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER ---
SIGNED THIS--.. _..__.DAY OF. NEW HOUSE SEWER
_ 19._. .p, - i--- — — ----
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS _. 7, AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
`1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND
AND STATE OF CALIFORNIA OR TH I M THE�EGAL OWN-
ER OF THE ABOVE ESC ll F�, D L OPERTY. BACKFILL SEPTIC TANKS(�
SEEP.PIT(S)E] CESSPOOLS -
SIGNATURE
OF PERMITTEE.
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