HomeMy Public PortalAbout6434 TRELAWNEY AVE_Sewer__ DEPAILTMENT OF COUNTY ENOnCon SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUMDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /-J/� -7--e /Q�/�
ADDRESS 6 Ll J�
FOR APPLIC TT RLL IN LGCALITY ern �I�/ CI
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LOCALITY�T- DISTRICT NO SERIAL NO PERMIT NO
GROM EAREST �c/Y1��1 p , S A 1D293 6063 S
,/ RECEIVED BY Ready for lopeoUon DATEISSUED
OWNER i CCOCy/ �'C{/ S—S —S3
YAIL /��} /T� J��� BK PG
ADDRESS (� �75L � USE ZONE OCCUPANCY YAP
OITY CD TEL NOf/� /2ZrS
CONTRACTOORR� �flQi�-j CO IMP NO {Z77 - 5_,E
ADDRESS l/�O. 1�� T IOBNO
CITY P/17 / EL MO y�f TRUNK PERMIT NO
REGISTRATION NO //Q WUNTY ROAD PERMIT NO �.32" 0
DESCRIPTION LOT N YI` * SFO ..�� YEpTOET NOROACHMENT
BLOCK TRACT 0 INDUSTRIAL
NO OF BLOBS WASTE APPROVAL
SIZE OF LOT NOW ON LOT Y CHARGES
USE OF
BUILDINGS /' CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIOSEWER ® t SSO SO RECEIPT NO _!ATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM IMI --
CONNECT ADDITIONAL SLDS OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 I O
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 _—DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK.SEEPAGEPIT OR
PITS AND/OR GRAINFIELD 2.00 STATION -L Z 2 DEPTH (p/
OE88POOL—DRYWELL
SPEC IAL CONDITIONS ONLY 200 MANHOLEp EFE CEl /
1 QTY' LOWER
TYPE OF CONN EVH LENGTH FROM2S,
OWNERS PERMIT $ 1 OO Y --- OU RB I� P L M LTO P L :7
AUTHORIZATION TOTAL FEE 7 50
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 �"//� DAY OFxZ 19� NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL �p
OWNERS AB/ENT BUILDINOORWORK CC
ADDRESS 7 �yPr�� Irl ` _ AMD%OR GRAINCTANK
IT(8)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL E]
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIRSEWER OR
REGULATI NB
PLUMBING AND SEWERS SEWASE DISPO L SYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCON ECT PLUG
SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SA FILL SEPTIC TANK
�j SEEP PIT(S)[] CESSFOO13
TWKWE,;F
SIGNATURE //
OF PERMITTEE _ �1
78AS42D 888 1/68 ,