HomeMy Public PortalAbout5317 ALESSANDRO AVE_Sewer__ 78A89YD
CE808 B 80 APPLICATION F R PERMITS12 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING _
ADDRESS
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JOHN A LAMMIE Count F En eer
CASSATf D GRIFFIN Sup t of Buildmg LOCALITY �?
I4EAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL /
DESCRIPTION LOT NO .f OWNER
BLOCK TRACT ,//
[,w 2--- MAIL C
ADDRESS _
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS ? DISTRICT NO P lMAP P CESSED BY� /BK PG
CONTRACTOR � /✓ `a t�
ADDRESS CONNECTION DATA
r
CIT / / TEL NO r STATION Q DEPTH
ZfjFE
REGISTRATION NO /c-/, ATE MANHOLE REFERENCE S r
COUNTY V LOWER
No I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 f TYPE OF TION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TOP L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
/ WORK TO ADDITIONAL BLDG OR @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
i
ALTER RE PAIR OR ABANDON HOUSE STATE ENCROACHMENT
EWER OR DI SPO
L SYSTEM @ $100 PERMIT NO
INDUSTRIAL
HASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 7 00 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ATE INSPCTOR S SIGNATURE
TO THE PUBLIC SEWE
SIGNED THIS S AY9 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT - '� '/ t / BUILDING OR WORK .�
ADDRESS _ SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS 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 THE LEGA R OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTI ROPERTY
SIGNATURE p SEEP PITS) ❑ CESSPOOLS
OF PERMITTEE
D" rm� ,
TI9 ROBERT A WOOD
p CASH SUPERVISING MECHANICAL ENGINEER
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