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Home My Public Portal About5332 ALESSANDRO AVE_Sewer__ 6A64 ,2D 7063 APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING `� / µ JOHN A LAMBIE County Engineer ADDRESS .� r N WILLIAM A JENSEN Sup t of Building LOCAL TY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER �- MAIL BLOCK TRACT ADDRESS NO OF SLOGS /� SIZE OF LOT NOW ON LOT CITY T NO USE OF DISTRICT NO GROUP MAP PRO SED BY BUILDINGS /BK P/GJ�J CONTRACTOR ADDRESS CONNECTION DATA STATIONDEPTH CIT TEL NO 'F STATE MANHOLE REFERENCE REGISTRATION NO COUNTY a 0 LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LEN FR HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L d PUBLIC SEWER @ 55 00 11w PC NO O SEPTIC TANK SEEPAGE PIT OR - JOB NO PITS AND/OR DRAINFIELD @ S1000 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO 3 CC PRIVATE DISPOSAL SYSTEM @ S3 00 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIVER IIAs[MINT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ E3 00 OVERFLOW SEEPAGE PIT DRAINFIELD L!J ETN CESSPOOL DRYW ELL MANHOLE @ 5500 HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE N SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERMIT S 21 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIB EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPEC R SIGNATURE SIGNED THIS Y OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK A DR 5 SEPTIC TANK SEEP PIT(S) I H BY ACKNOWLEDGE THATN HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND ATE THAT THE ABOVE IS ORRECT AND AGREE TO COMPLY WIT ALL COUNTY ORDINANCE AND STATE LAWS REGULATING PLU ING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM, CALIFORNIA OR VTHE LEGA WNER OF D INTEND TO DISCONNECT PLUG AND RESIDE IN ABOVE ESCRIBED TI P T ABANDON HOUSE SEWER SIGNATURE � BACKFILL SEPTIC TANKS ❑ OF PE IT E SEEP PITS) ❑ CESSPOOLS ❑ VM O GASH LMATION ROBERT A WOOD CK SUPERVISING MECHANICAL ENGINEER b1w0 j 1 7E-o SEP 8i 0 p 7.00 o