HomeMy Public PortalAbout5510 ALESSANDRO AVE_Sewer__ c SOS D APPLICATION FOR PERMIT
eeoe a as COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUELDING AND SAFETY DMSION 3UILDING
JOHN A LAMBIE County Engmoer ADDRESS //
CASSATT D GRIFFIN Sup t of Building LOCALITY / /r V
47
FOR APPLICANT TO FILL IN
NEAREST
ST L.1 C S
LEGAL `
DESCRIPTION LOT NO — OWNER
B TRACT ( MAIL
4DDRESS
r 0 F BLDGS
S Z F LOT OW ON LOT 'ITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP7BK
P PROCESSED BY
CONTRACTOR 1 a�
�u� �"A'ADDRESS jON ATA
CITY TEL NO �. y(�Olf STATION -t- O DEPTH
TATE
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O OUNTY MANHOLE REFERENCE UPPER
REGISTRATION NO C `J � 0
No I DESCRIPTION OF WORK I F E
HOUSE SEWER CONNECTING TO
PUBLIC SEWER /g $3 00 ®ta
SEPTIC TANK SEEPAGE PIT ORTYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 �Y CURB P L M L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK C HOUSE SEWER Q $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO
INDUSTRIAL t
_WASTE APPROVAL "
CHARGES
OWNER S PEM IIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE O n REIMBURSEMENT FEE _114-
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER (7
SIGNED THIS Y OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGE AGENT /T BUILDING OR WORKBUILDING OR WORK D
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
AHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
LDESCRIBED
NIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
RESIDENTI L PROPERTY BACKFILL SEPTIC TANKS❑ _
RESEEP PIT(S) ❑ CESSPOOLS❑MITTE
OF VALMATIOROBERT A WOOD
CK Y 0 CASH SUPERVISING MECHANICAL ENGINEER
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