HomeMy Public PortalAbout5303 SANTA ANITA AVE_Sewer__ DEPAICdMENT OF COUNTY ENOHNZEE SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING. AND SAFETY PERMIT APPLICATION '
COUNTY OF LOS ANGI LES
WILLIAM J. FOX, COUNTY ENGINEER ADD EISS ,3(/ � _� r .�
FOR APPLICANT TOS F��LL IN LOCALITY
BUILDING /�/ NEAREST jn
ADDRESS �, �rJ o CROSS'ST.
LOCALITY - 1 DISTRIX 0. SERIAL N0: PERMIT NO.
NEAREST --- L A•- O � .S
CROSS ST. ^ RECEIVED Ready fer Inspection DTE ISSUED
OWNER CG �r�{�%r'���Ry 1 'v! ���" �
ADDRESS - ` USE 20NE' OCCUPANCYml+aP---
CIT �r� TELAO. �� f BK dz .
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CONTRALTO CO.IMP.NO.
ADDRESS
_ JOB NO.
_
e TRUNK PERMIT N0.
REGISTRATION N0. N COUNTY �%`i
ROAD PERMIT NO.. ,> f
LEGAL
r+.p
DESCRIPTION OT NO , aZ0 STATE ENCROACHMENT
-� PERMIT N0:
1,47BLOCK TRACT �Q f INDUSTRIAL
NO.OF BLDOB. WASTE APPROVAL
SIZE OF LOT 27NOW ON LOT CHARG
USE OF
BUILDINGSCONNECTION CHARGE FE
/moi rr -
NO. DES I. ION -OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER es '8.50 �^�` �� RECEIPT NO. q DATE BY
HOUSE SEWER CONNECTING TO I�
PRIVATE DISPOSAL SYSTEM 1:00
CONNECT ADDITIONAL BLDG.OR EXCEPTION ECORDED
WORK TO HOUSESEWER 1.00
ALTER OR REPAIR EXISTING NO I DA E I BY
SEWER OR DISPOSAL SYSTEM IAO
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 _ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR -7
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL.-DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 ^� ° HOLE REFERENCE
Z�el f� �.# R ' L_ E
STYPE OF CONNECTION. LENGTH FROM �"--L_
-
- OWNERS PERMIT
00 r / "` M.L.TO P.L. 4 3 L
AUTHORIZATION TOTAL FEE �' '� ®/V
V
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE.ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S'SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-__._.. D _. 3_. _ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS A30 BUILDING OR WORK
SEPTIC TANK,SEEP.PIT($)
ADDRE8 _. _ .._ AND/OR DRAINFIELD
1'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE 18 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/O.R LICENSED AS REQUIRED .BY' LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFOR IA OR THAT I AM THE.LEGAL OWN-
ER OF THE ABOVE D IBED IDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE_ ,,_ `�,y,s.r�l,��,r��.
OF PERMITTEE.
70A0421D 663 1/53 _1;