HomeMy Public PortalAbout5827 AGNES AVE_Sewer_6/3/1957_ 76AG42D FmoC A T I O N FOR
PERMIT
S&E-663 11.55
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING /
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ��_. �/% Ae
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER -
: DESCRIPTION COT N0. /�
/
BLOCK TRACT MAIL� ADDRESS
� NO. OF BLDGS. CITY TEL. NO.
_SIZE OF LOT,56)/(/G/9:) NOW ON LOT
USE OF y'F DISTRICT NO. GROUP MAP
PG
BUILDINGS _ Tr `J
CONTRACTOR 70,v/, //
CONNECTION DATA
13.
ADDRESS` -� J
CITY EL. NO. STATION 0 '� !/a DEPTH
MANHOLE REFERENCEUPPER
❑ STATE _ c W E
REGISTRATION NO. ❑ COUNTY ,
No. DESCRIPTION OF WORK FEE
C g
HOUSE SEWER CONNECTING TO TYPE OFON LENGTH FROMY, g P.L. M.L.TO P.L. J
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. N0.' J
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 OB NO
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. �®�s �
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 C>d�? PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE /" �j� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING p
1.0 THE,PUBLIC S WER. ��', NEW HOUSE SEWER
SIGNED THIS DAY OF J 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG
J1 SEPTIC TANK,SEEP,PIT(S)
ADDRESS —/ .3 F AND/OR DRAINFIELD
I 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 I AM PROPERLY REGISTERED AND/OR - DISCONNECT PLUG AND
F LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNE OF THE ABOVE -,
DESCRIBED RESIDENT ROPERTY. BACKFILL SEPTIC TANKS C) ❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITTEE—Alf.� �
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. Id. 0. CASH
�f'r'Q 8 7 1 5 1 M1 3 4 5.50 N