HomeMy Public PortalAbout5341 SANTA ANITA AVE_Sewer__ aTBMNT OF-COUNTY MGM= SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY y PERMIT APPLICATION- — COUNTY OF Lob ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
X335-37- FOR APPLI T TO L. IN—
NEAREST
LOCALITY
ADDRESS�i � /7` CR0S T.
LOCALITY �_ DISTRICT NO. a/ResdYforl�peotiol +� PERMIT NO.
NEAREST I O V �& �
CROSS ST.
CE``I��E,�,D B DATE ISSUED BY / DATE
OWNER,J56&,, �'KJ �ar��' �R� /1 '7615
ADDL 8S p U$E NE OCCUPANCY r �
�� .� ,4
//a•�y�dS rpt. o TEL,NO.
CONTRACTOR
/�• � - CO.IMP.p0. �
ADDRE aF JOB.NO.
C " jy -10TEL.NO '.y j :TRUNK PERMIT N0.
REGISTRATION NO. �� 1 Fr
COUNTY ROAD PERMIT NO. r a
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT PERMIT NO. T
BLOCK13 TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT J? NOW ON LOTS CHARGES _
USE OF
BUILDINGS CONNECTION CHARGE FEE 1
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
i HOUSE SEWER CONNECTING TO P
PUBLIC SEWER 0 $ 5.50 RECEIPT NO. I I ATE,f I BY
HOUSE SEWER CONNECTING TO �j
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION kECORDED
3 WORK TO HOUSE SEWER 1.00 ��VV
ALTER OR REPAIR EXISTING NO. I DAT= BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CON ECTION bATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION / D PTH
CESSPOOL- DRYWELL ¢�
SPECIAL CONDITIONS ONLY 2.00 P A UPPER EFERENC�ENI LOWER
TYPE OF CONNECTION LENGTH FROM
.Y. CURB P.L. " M.L.TO P.L.
OWNERS PERMIT $ 00
AUTHORIZATION I TOTAL FEE
I 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__ ___DAY OF 19 ,NEW HOUSE SEWER a /f - I`
_
CONNECT ADDITIONAL
WORK g�
OWNERS AGENT...._....._r BUILDING OR WORK v /
SEPTIC TANK,'SEEP.PIT(S)
-ADDRESS..._......._. ._.. ._ _..___ _._. .. ._.._.. . ..,._.._..=. AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:IDRYWELL I]
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 I AM PROPERLY REGISTERED
AND LICENSED AS REQUIRED BY LOS ANGELES. COUNTY -DISCONNECT PLUG AND
ND/ORASTATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE D RISE RESIDEN/AZLOPERTY: BACKFILL SEPTIC TANKS
SIGNATURE �/� SEEP.PIT(S)0 CESSPOOLS❑OFPERMITTE _:!r? + :,.__
76A642D S&E 665 4/54