HomeMy Public PortalAbout6333 TRELAWNEY AVE_Sewer_7/8/1954_28301S house sewer connection to public sewer • f
DEPARTNOENT OF COUNTY ICN(UaTI= SEWER=SEWAGE DISPOSAL 1
DIVISION OF HUMDING AND SAFETY PERMIT APPLICATION
COUNTY OF L08 ANGELS _
WILLIAM J�ox._FCUNTY ENGINEER ADO.E188���3 '1
?R APp11/�e/J,T T RLL IN
IWASTE
ALITY
ADDRESS
) / REST
BUILDING
UIL IN ) J JID��..//��A_wTN_I�.LJREST
LOCALITY T • TRICT NO RgET IAT IWFNUoo ^^ PERMIT NO C
NEAREST S f O 3 o / S
CROSS 8T
VED DATE ISSU Y D TE
OWNER MAILEZONE OCCUPANCY MAP
ADDRESS BK PO
CITY TR - / �7 - 3CONTRACTO 02,Nn MF NOL /2S _ADDREBS,LC�Z_g14 4A I/ _0� NO --TCITY�, Q', � �. <tTELMD.T m 1�� NK PERMIT NO
6REBIBTRATION NO 1,�/ � ['' � CD PERMIT NO
LEGADESCRIPTIO 1 LOT NO ,Y4 K3E ENCROACHMENT
y MIT MORDCR ' TRA" -L �� 15� STRIALTEAPPROVAL
SIZE OF LOT NO OF BLDG&
NOW ON LOT I CHARGES
BUOF
IE DINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE /J
HOUSE SEWER CONNECTING TO
PUBUCBEWER M S SJNDATE BY
HOUSE SEWER CONNECTING TO (J _ _S
PRIVATE DISPOSAL SYSTEM IES _
CONNECTADDI IGT NAL BLDG 08 EXCEPTION RECORDED
WORK TO HOUSE SEWER IDE _
ALTEROR irP�REXISTINS NO DATE BY
SEWER OR DISPOSAL SYSTEM 100 _
DISCONNECT AMC ABANDON SEWER
_ AND/oR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AMD/Ofl GRAINFIELD 2d8 STATION DEPTH Gj
CESSPOOL-DRYWELL J
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
V CURB P L ML TOP L
OWNERS PERMIT i 1 Do
AUTHORIZATION TOTAL FEE SD _ n
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED `y (/
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SISN 'TURE .D TE
DWELLING TO THE PUBLIC SEWER - / '` q
SIGNED THIS DAY OF ( NEW HOUSE SEWER i ILLij>U�l�l/ - ,S
OWNER ON CONNECT ADDITIONAL
OWNER( AGEST 'P BUILDING Ofl WORK
SEPTIC TANK SEEP.PIT(S)
ADDR[SB AMD/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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 BEWER6 SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE QESCAIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TAkRI'T
SIGNATURE 1 ' 1 BEEP PIT(8)[] CESSPOOLS0 I
OF PERMITTER _ _ `
TOA6UID SQB 6W 6/66 I