HomeMy Public PortalAbout5026 DOREEN AVE_Sewer_8/25/1955_'6A84lG APPLICATION
FOR PERMIT
E86
BC DIVISION OF BUILDING AND SAFETY
1
SEWER—SEWAGE DISPOSAL
Department of Lo Angeles Oi
C.O1 aI Loe
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ADORE SG Q � YJ C///•— W /✓l_� �
FOnty
T'YEN
WM. J. FOX. COUNTY ENGINEER
CABBATT D. GRIFFIN. BUP•i OF BUILDING
LOCALITY`'
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FOR APPLICANT TO FILL IN
'/'�
NEAREST
cxosssT.
LEGAL
DESCRIPTION LOT NO.
BLOCK J) TRACT / /..!/7 /�i
MAIL / nn
ice.
- --�-- - - -
___ NO. OF BLDGS.
SIZE OF LOT
7
ADDRESS i a
=-
CITY >( a TEL NO.
1 [
BUILDINGS
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STRICT NO. GROUP
tLOJ` 1 ''`!�
CONTRACTORv
BK PIS
L 37
ADDRESS
CONNECTION DATA
CITY
TEL. NO.
REGISTPAT10N NO.
NO. I DESCRIPTION OF WORK
/ I HOUSE SEWER CONNECTING TO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD
CESSPOOL- DRYWELL
SPECIAL CONDITIONS ONLY
OWNERS
IHAVE
TRACTOR
TO THE
SIGNED
OWNER
OWNERS
Y
PERMIT
TOTAL FEE
❑ STATE
❑ COUNTY
FEE
5 3 0
1.00
1.00
STATION DEPTH
MANHOLE REFERENCE
UPPER
TYPE OF CONNECTION LENGTH FROM
Y. CURB P. L. M. L. TO P. L.
Sfi ooGrs' --A. S G a cA,nF-�
CO. IMP. N0. J ,/ JOB' NO.
1.00 _. _ TRUNK PERMIT NO,
1.00 STATE ENCROACHMENT
PERMIT NO.
2,00 INDUSTRIAL
WASTE APPROVAL
2.00
-- CONNECTION CHARGE FEE
E 1 00
<73 REIMBURSEMENT FEE .
�ISNA WELL
INGDWELLING G APPROVALS
1 5"S NEW HOUSE SEWER
CONNECT ADDITIONAL
BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
ROAD PERMIT NO.
CHARGES
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL ❑ DRYWELL ❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCDISCOHOUSE BEAVER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.,-' y BACKFILL SEPTIC TANKS ❑
SEEP. PIT(S) ❑ CESSPOOLS ❑
SIGNATURE
OF PERNITT/
E° ��-- a
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WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
AC 7 1 5 6 k2 AUG 2 5
BY DEPUTY . t7Bi 5 51 AUG 25
LOWER
'!/O (/
DATE 1I INSPECTOR'SSIGNATURE
45
BY G%� BY .1/' /-7 v
L DEPUTY V Y Y LJ/�/ / `/ �� / DEPU
FOR DEPARTMENT USE
REQUIRED INFORMATION
1. INDICATE ALL BUILDINGS ON PROPERTY.
2. INDICATE AND DIMENSION SEWAGE DIS-
POSAL SYSTEM WITH TIE DISTANCES TO
BUILDINGS AND PROPERTY LINES.
3. INDICATE SIZE OF SEPTIC TANK—DEPTH OF
SEEPAGE PITS)—SIZE OF CESSPOOL(S)
4. INDICATE NORTH DIRECTION ON PLOT.
5. INDICATE BOTH STREETS IF CORNER.
FIELD NOTES 8 -�9 �.S z�t�r� 1+ k— C,
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