HomeMy Public PortalAbout6006 AGNES AVE_Sewer_3/28/1956_ D
s IN E-669 11.95 APPLICATION FOR PERMIT 1
S 8:E-8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ,
FOR APPLICA�N�Tj TO,FILL IN CROSS ST. � -ZNALEGAL
DES RIPTION LOT NO. `-r" �� OWNER - -d& ey1I
BLOCK TRACT MAIL
0.
SIZE OF LOT �sdl `� NOWOONBLOTSCITY
6
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
, ,�^C�P•r
f— BK PG
CONTRACTOR
ADDRESS R ( —� CONNECTION DATA
L. NO. ` STATION j DEPTH
` MANHOLE EFEREN
1 0C44,.1 ❑ STATEEJ� � e LOWER
REGISTRATION NO. J1 COUNTY I
V'
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF TION LENGTH FROM
PUBLIC SEWER _Y• (CCURB P.L. M.L.TO P.L.
@ $3.50 -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0.
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO - p0
PRIVATE DISPOSAL SYSTEM Q $1.00 � TRUNK PERMIT N0, ROAD PERMIT N0. � J �y6.�
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER c@ $1.00 _PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 'WASTE APPROVAL
1
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT g 1 00
AUTHORIZATION TOTAL FEE _'. REIMBURSEMENT FEE -
•�' APPROVALS DATE INSPECTOR'S SIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA ED CON-
. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ff
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR 4= "p BUILDING OR WORK -
OWNERS AGENT ,I
SEPTIC TANK,SEEP,PIT(S)
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ABANDON CT PLUG AND
CALIFORNIA OR THAT 1 AM THELEGALOWNER OF T11f
ABOVEHOUSE _
DESCRIBED RESID ,^L PR�/O.P RT Y., ,9///�yS I BACKFILL SEPTIC TANKS❑ d
SIGNATURE
OF PERMITTEE Yf ��9 '��' '^r ° SEEP.PITS) ❑ CESSPOOLS
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
M.0. LASH �
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