HomeMy Public PortalAbout5950 AGNES AVE_Sewer_1/7/1958_ ,
6D
S&E 89 11 99 APPLICATION FOR PERMIT 1
S& 8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engmeer
CO13IIty Of LDS Angeles BUILDING / /
,
JOHN A LAMBIE COUNTY ENGINEER ADDRESS +� ✓
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY J
FOR APPLICANT TO FILL IN CROSS ST l.r � %c� �
c
LEGAL c) Cil OWNER
DESCRIPTION LOT NO 7
-- i
BLOCK TRACT MAIL
ADDRESS z4-a
kO OF BLDGS
SIZE OF LOT - NOW ON LOT r CITY TEL NO r
USE OF /� °
BUILDINGS �,.� �/N'1<-+'r'Ls'Q DISTRICT NO GROUP MAP
PG
CONTRACTOR ��C cz– r�
ADDRESS �Jg,� y L) CONNECTION DATA
STATION DEPTH
CITY TEL NOA -t, ,9447 )— MANHOLE REFERENCE G e) g / PPE
❑ STATE L
REGISTRATION NO Y �a ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y UR P L M L TOP L 5
PUBLIC SEWER @ $3 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD t ) P C NO
EXTN CESSPOOL DRYWELL MANHOLE Q $ 2 00 CO IMP NO / 10B NO
HOUSE SEWER CONNECTING TO _' 77 7
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO 71 //
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT y
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL _
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT 1 00
AUTHORIZATION TOTAL FEE � REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSP CTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER _ NEW HOUSE SEWER
SIGNED THIS DAY nF / 1 19 CONNECT ADDITIONAL
OWNER OR ,,,,I BUILDING OR WORK
OWNERS AGENT '"'/l SEPTICTANK SEEP PIT($)
ADDRESS 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA�.OR THAT I AM THE LEGAL- OWNER OF THE ABOVE
DESCRIBED,RESIDENTIAL PROPERTY / �q �„ / BACKFILL SEPTIC TANKS❑
SIGNATUE ,,,.,�`� �7E"yt ) 7 SEEP PIT(S) ❑ CESSPOOLS 5
OF PER EE
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK m 0 CASH ~
--�&O i 54330 JAI 7 4 A 460