HomeMy Public PortalAbout6011 AGNES AVE_Sewer_3/2/1959_ D
S&E-683 11.59 APPLsICATIO``N FOR PERMIT 1
8&E•8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAG DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING J/
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS WO I J 4riNc S
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST /d _y
iIROSS ST. /� ILS ' I t, ,,, �a c
LEGAL
DESCRIPTION LOT NO. �~!9 ,�X S: It-10 OF AJ `j r,' () OWNER / t4A t4 /-
MAIL
BLOCK TRACT
6 6 / _ADDRESS I �'I �- C_ 1,NOCI (-
SIZE OF LOT NOW ON LOTS CITY 'PL 0"j TEL. N0. y(jvC
USEOF Q DISTRICT NO. GROUP MAP
INGS
BUILD
BK PG
CONTRACTOR f
ADDRESS � r//} _ CONNECTION DATA
`z � La.J „7 � ���..�. � 14.
�
_STATION DEPTH
CITY L O��� TEL. NO. STATE� ��/d MANHOLE REFERENCE
REGISTRATION NO. l Cn �? l,' ❑ COUNTY ER
NO. DESCRIPTION OF WORK FEE
TYPE OF RE TION LENGTH FROM
HOUSE SEWER CONNECTING TO 7 O y, CURB P.L.
M.L.TO P.L.
I PUBLIC SEWER @_$3.5010
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. N0. J �Q JOB N O
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO rte,y
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.�,36 3 -
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 __PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL _
SEWER OR DISPOSAL SYSTEM @ $1.00 '._WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ OO
AUTHORIZATION TOTAL FEE O _REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR �(1� ,,_BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS ._AND/OR DRAINFIELD
1 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 OS ANGELES UNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I A THE LEGA 0 NER OF THE ABOVE
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PITS) ❑•CESSPOOLS[:) I�
OF PERMITTE _
JOHN A. LAMBIE, CO KTY
ENGINEER \ _
VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M� CASH
L tC(!^�O.0 2 9 1 0 fA i°��iR -21 '0 A 5.00
r� '