HomeMy Public PortalAbout4808 ALESSANDRO AVE_Sewer__ -61
76A642D P® UCATION FOR PRWIT
6A642 ;
COUNTY OF LOS ANGELES SEWER-SEWAGE D9SP SAL
DEPARTMENT OF COUNTY ENGINEER - ,, __... MUMMM
BUILDING AND SAFETY DIVISIONBUILDING �.
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building LOCALITY
mm. lm,ffi§ft NEAREST
FOR APPIICANT TO FELL IN CROSS ST.
LEGAL C
DESCRIPTION LOT NO. , `J[�� NER
MAIL
BLOCK TRACT `sem."'® ADDRESS
yy NO.OF BLDGS.
SIZE OF LOT Is�y� �i NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICT N0. GROUP MAP PROCESSED BY
K �G
CONTRAC
ADDRESS C 'e CONNECTION DATA
TEL 0. GG STATION �� , DEPTH
COSTATE MANHOLE REFERENCE / i`
REGISTRATION NO. 1(f 6� ❑ COUNTY' + 22,
LOWER'
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO 6`
<` PUBLIC SEWER @ $3.00 L�
i; SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM f5
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L. [!
OVERFLOW SEEPAGE PIT,DRAINFIELD �-
EXTN..CESSPOOL.DRYWELL @ S2.00 !L
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ SLOO CO.IMP. N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR '^, TRUNK PERMIT NO. ROAD PERMIT NO. l OL
WORK TO HOUSE SEWER @ $1.00 O
SEWER OR DISPOSAL SYSTEM ABANDON HOUSE @ $I OO STATE ENCROACHMENT
PERMIT NO. U
INDUSTRIAL !L
WASTE APPROVAL
'AY1�
CHARGES Z
O�apvYMR'S° PERMIT 51 21 OO ,`= CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING (DATE INSPECTOR
APPROVALS = SIGNATURE
Sj
TO THE PUBLIC SEWER.
1A, a+'
SIGNED THIS DAY OF 19— !: NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL 6
r. OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS ' AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1' HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY y CESSPOOL IDDRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
_-,' SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM HE LEGAL OWNE OF THE ABOVE
DESCRIBED RESIDENTIAL PRO TY. /� BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S ❑ CESSPOOLS
OF PERMITT
A'T10N ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL.ENGINEER
577 Dtc 60