HomeMy Public PortalAbout4849 AGNES AVE_Sewer_7/7/1999_ T �� c- c � 1
GA642D 62
7APPLICATION FOR PERMIT
8A842
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION SUILDING
JOHN A LAMBIE County Eng n ADDRESS 8LJ Agnes
WILLIAM A JENSEN Sup t of Bu Idmg
LOC LITY
FOR APPLICANT TO
C EOSSSST Q �. Rd
LEGAL 11�
DESCRIPTION LOT NO y OWNER n'IY� r
If r MAIL �S� Arne S
BLOCK TR CT ADDRESS } 1
SIZE OF LOT NOWNO OON LOTS ' CITV )� r')t'.'7 TEL NO 4L 74824
USE OF f
BUILDINGS DISTRICT NO GROU MAP PROCESSED BY
/' 's-0211
0 1 BK PG
CONTRACTOR J & D Plumbin GO aIY .� �
ADDRESS 1 SO San Gabriel .Llvd, CONNECTIONDATA
CITY San Gabriel TEL NO At 70 STATION Q\ DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO 126 COUNTY `l LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LEN TH FRO
HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L
PUBLIC SEWER $5 00
SEPTIC TANK SEEPAGE PIT OR ` P C NO
PITS AND/OR DRAINFIELD 0 $1000 CO IMP NO S JOB NO V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO �.
PRIVATE DISPOSAL SYSTEM 0 S300
CON ECT ADDITIONAL BLDG OR AFFIDAVIT w I I RECORD INSTR NO DATE
WORK TO HOUSE SEWER 0 $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $500
ALTER REPAIR OR ABANDON HOUSE
HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
W STE OV
OWNERS PERMIT $ 2 00 CHARGES
AUTHORIZATION I TOTAL FEE 1 7 , 00 CO NECTION CH RGE FEE
I HAVE AT TH S D TE CONTR CT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE A OVE DESC IBED EXIST NG DWELLNG
TO THE PUBLIC SE !!__ APPROVALS DATE j INSPECTORS SIGNAT RE
SIGNED THIS DAY OF )k-3
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_
I' CONNECT ADDITIONAL
(7/ BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP PIT(S)
I HE EBY ACKNOWLEDGE THAT 1 HAV EAD THIS APPLICATION AND/OR ORAINFIELD
NO STATE TH T THE OVE IS CORRE AND AG EE TO COMPLY
LRESIDE
COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
AND SEWERS CESSPOOL ❑ DRYWELL
Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
LENSED
OR THAT 1 AM THE LE OWNER OF AND INTEND TO DISCONNECT PLUG AND
T OVE DF�^aGRISE R SIDENTI L PROPERTY ABANDON HOUSE SEWE
aE BACKFILL SEPTIC TANKSMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑
�
VALIDATION ROBERT A WOOD
CK M O SUPERVISING MECHANICAL ENGINEER
CASH
tF 14
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