HomeMy Public PortalAbout4946 AGNES AVE_Sewer_1/31/1961_ � L
CE8082aBD APPLICATION 'FOR P RMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING _
ADDRESS
OHN A LAMBIE County Engineer
C SAT! D GRIFFIN Supt of Tu d4 LOCALITY
am NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL �/�
DESCRIPTION LOT NO SQ O -,�Q a OWNER
BLOCK TAMAIL CT ADDRESSAV
-�' NO OF BLDGS
SIZE OF LOTS D 40'U NOW ON LOT CITY TEL NO
USE OF
DISTRICT NO G MAP PROCESSED BY OUP
BUILDINGS BKS PG� n '
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TE(L�NO ' STATION DEPTH
IIPPFR
REGISTRATION NO q�S �j 7 �p� STATE MANHOLE REFERENCE �f
COUNTY
No I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO a
PUBLIC SEWER @ $3 00 1 TYPE OF CTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
CON
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT WITH THE IINGAMED DWELLIING APPROVALS DATE INSPEC OR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS AY OF 19_ NEW HOUSE SEWER ! (.
OWNER OR _.�- CONNECT ADDITIONAL
OWNERS BUILDING OR WORK
ADDRE SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESID TI P OPE BACKFILL SEPTIC TANKS ❑ /
SIGNATURE SEEP PITS E3 CESSPOOLS �y
OF PERMITTE
®rALIDATION ROBERT A WOOD
CR Y 0 CASH SUPERVISING MECHANICAL, ENGINEER
I [Foo G30 ;zJ AN 3 - 0 D 600 `�