HomeMy Public PortalAbout5335 ALESSANDRO AVE_Sewer__ TEMPLE CHT '
l D 8 S>t
cEsoAPPLICATION FOR PERMIT
EBO
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
ADDRESS ) �� S
OHN A LAMBIE County E.Wneer
C AIT D GRIFFIN Sup t of$uild�ng LOCALITY
OQ
NEAREST
FOR APPLICANT TO F l IN CROSS ST
LEGAL r'�
DESCRIPTION LOT NO OWNER e Q
/
BLOCK TRACT / MAIL
�✓ ADDRESS
NO OFBLDGS
SIZE OF LOT v NOW ON LOT CITY TEL NO
USE OF
! DISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS `J
BK
CONTRACTOR 4p
ADDRESS N p� CONNECTION DATA`
CITY &14 ov`CL.TEL NO U� STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO COUNTY LOWER
NO DESCRIPTION OF WORK FEE9
HOUSE SEWS RCONNECTING TO @ $3 00171—
TYPE O� CONNE TION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L
PITS AND/OR DRAINFIELD @ $3 00 i 1
OVERFLOW SEEPAGE PIT DRAINFIELD
EXT N CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IM NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERNIIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 1 10/Q REIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEREINAMED CN
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19NEW HOUSE SEWER
OWNER OR Az�a- � CONNECT ADDITIONAL
OWNERS AGENT "
BUILDING OR WORK V (/
ADDRESS -S
t SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRpPjRTY BACKFILL SEPTIC TANKS ❑
SIGNATURESEEP PIT(S) ❑ CESSPOOLS El
OF PERMITTE 61 A
�P VALIDATION ROBERT A WOOD
CE M G CASH SUPERVISING MECHANICAL ENGINEER
Lk-'o 3 G 1 01�3 U-T � 1 J U 3 C O