HomeMy Public PortalAbout5318 ALESSANDRO AVE_Sewer__ r
/ .yr
s&E48 9,159 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depcxtment of County Engineer p /� A
County Of LOS UNTYAngeles BUILDINAD RESSG /O f�Lj��/7��<,sQ'��1�0 �/</&
JOHN A LAMBIE COUNTY ENGINEER Y
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
A TO L I .
NEAREST T c
L `
DESCRIPTION OT NO OWNER
t MAIL
BLOCK TRACT ADDRESS
/ rf NO OF BLDGS TEL NO
SIZE OF LOT / NOW ON LOT / (�J
USE OF
BUILDINGS ) DISTRICT NO GROUP MAP
BK PG
CONTRACTOR " ,
ADDRESS
CONNECTION DATA —��
� `
CITY EL N STATION '341, \7 DEPTH
If MANHOLE REFERENCE q f r f UPPER
❑ STATE
REGISTRATION NOC3COUNTY v ;7�/ z
NO DESCRIPTION OF WORr FdW
HOUSE SEWER CONNECTING TO Y TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER
@ $3 50 CURB P L M L TO L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD , P C N
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CO IMP NO /ter JOB N
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
7CK (f'
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
L
CONNECTION CHARGE FEE r
OWNER S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIE TURE
TRACTOR TO CONNECT THE ABOVE DESCRI ED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
CONECT
SIGNED THIS��DAY OF 19
OWNER OR l' BUILDING OR WORKAL
OWNERS AGENTS-
SEPTICTANK SEEP PIT(S)
ADDRESS SR�J�P_ 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
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STAT OF ABANDON HOUSE SEWER / Ej
CALIFORNIA OR THAT I AM THE LEGAL ER OF TH B VE
DESCRIBED RESIDENT, OPERT BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S) ElCESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK M 0 ASH
1 71N FEB 10 4 A 5 5 0 M
oC ,