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COUNTY OF LOS ANGEI.ES
DEPARTMENT OF �OtTi3TY �fiGINEER-FAC�LITIES ,
; AIVISION OF BUILDING AND SAFETY
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STATEMENT TO BE SIGNID BY.OWNER`PRIDR TQ ZSSUANCE OF SWi2�tING POOL PERMIT.
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jWater dra3ned from swimming pools must not eacroach on abutting property.
' The fol.lowing are legal methads of swimming pool waste water disposal:
�
� le To a sanitary sewer through a 3" P-trap legally installed under
permit from the Building and Safety Div3sion of the County of
i.oe Angeles. This applies only to property which is connected
to a public sewer. Swimming pool waste water shall not dis-
charge to a private sewage disposal system. �
' 2. To a storm sewer or established storm channel �rhich abuts the
; property if permission can be obtained from Che County Flood -
Control District. The general information telephone number
there is (213) 226-4111.
3. To the street if a permit is first obtained from the County Road .
Department (213) 226-8188. � -
4. On the property if the property is large enough to insure that �
runoff will not encroach on abutting property. ;,,
S. In the case where none of the above can be accomplished, the pool �
contents must be removed by tank truck.
This is to certify that I have read and undersCand the foregoing and agree
to pass this information sheet on to the nexC subsequent owner.
�%����- ��/- ���
�s Signature Date
Subsequent Owner's Signature Date
Subaeqvent Owner's Signature Date
Subsequent Ownerts Signature Date
EL�I:�a 53
Form G - Twc► capies required.
Owner retains one.
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4. �iST.OfF.
TC• COtINTY 0€'�,OS ANGELES
DEFkAPIvl�NT OF COUNTY ENGINEER Date �/.� —,Y�"
CLAIHf fOR REFUN�
C1oia:for refund oF permit and otherfees paid, as��provided by applicable ordinances establishing Building,
Code;plumb;ng Code;S�itary Sewer sid Industrlal Waste Ordinance; Electricc]Code;Mechanical Code. �
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Claim is hereby made for the refund of$ I.1`f• s�V ,which is eighty percent(80%)of
the fee paid(S__j�� �!) )for the permit or other service shown 6elow. (Check one only.).,.
� BUILDING � ELECTRICAL O REGISTRATiC)N FEE,
PERMIT PERMIT COPETFtACTOR
� PERMITG 0 BLDG.&SAFETY � J�OURNEYMACd��EE,
� PLUMBING � SEWER-5E'h'AGE �
PERh1IT DISPOSAL PERMIT
� FEE FOR INSPECTIONS FEE FOR SPECTAL
&RECORD PLANS � STUDY
� FEE FOR PROCESSING PLAN CHECK FEE,
SEWER EASEMENT � SANIT'�RYSEWERS
� PLAN CHECK FEE,INDUSTRIAL � FEE FOR PROCESS-
WASTE FACTLITIES ' ING REIMBURSE-
MENT IaBS
Permit No. �_%''�� Receipt No � Date Issued �w/�—�'"..�-
, Job Number or . � ��� � � �} � ,�
�Job Address �G'= f-in�"'`^tl/ ,�.�,� �..*Q- �}'s==�-,x,,�,� ,�i.f✓J
I herehy certify that no rovork was commenced or-dane under the permit or receipt issued and that the infor-
natio❑ written above is tr and con�pct to y best knowledge and beliaf, and that this cluim is justly due
"and h¢s n 4-6�en paid. y'�� � r� �
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Sf pEEf Claimant to fill in a11 necessary spaces above this line Z��E
I hereby certify that a11 the terms�id conditions of the applicable ordin�ces qoveming refunds have been
strictly and fully complied with, �d this refund is APPROVED.
RPPROVED BY— � DIS1'ftICT
� ��IAis[rlct Engineer-pr-Oihar Supprvinotr�,;: , . J
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The original copy of the germif or ieceipi issaed musf he attached to and t»ede a parf of this claim
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