HomeMy Public PortalAbout5514 ALESSANDRO AVE_Sewer__ i
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CAPPLICATION FOR PERMIT
canoe a Be COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING jv
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JOAN A LAMBIE County Engmeer ADDRESS
CASSATl D GRIFFIN Sup t of Building LOCALITY
FOR APPLICANT TO FILL IN ceoss sr . eo B g
LEGAL14 e
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DESCRIPTIO LOT NO S, +7� 1� ^'d0 OWNER
BLOCK TRACT /// ,Q MAIL pp
f ADDRESS O l
NO OF BLDGS -7 /,�
SIZE OF LOT ll V NOW ON LOT CITY /i TEL NO
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USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
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CONTRACTOR BPG
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ADDRESS f CONNECTION DATA
CITY TEL NO Q��j�6 STATION t 0 !7 O DEPTH
Q� STATE MANHOLE REFERENCE UPPER
REGISTRATION NO / COUNTY ` LOWER
NO DESCRIPTION OF WORK EE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $3 00-
r SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION-,,, LENGTH FQO
PITS AND/OR DRAINFIELD $3 00 iY CURB P M M L T
OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE Q $2 00
HOUSE SEWER CONNECTING TO P
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IM B
CONNECT ADDITIONAL
WORK TO HOUSE SEWER BLDG OR @ $1 0000 MI N 0 P v1
O
ALTER REPAIR OR ABANDON HOUSESTATE STATE ENCR ACHMENT
SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT.NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OAR$ PERMIT2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE -
I HAVE AT THIS DATE A CONTRACT WITH E HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS-------DAY OF 19— NEW HOUSE SEWER /
OWNER OR � � i / BUILDING ORCONNECT DWORKAL (� // P ,ffill ,,(,/f/1
OWNERS AGENT `�C/ ! ,j�lk[/f(/
SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ T IS 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 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 RESIDENT AL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP PIT(S) [ICESSPOOLS
OF PERMITTE
®r VALIDATION ROBERT A WOOD
CK m o CASH SUPERVISING MECHANICAL ENGINEER
Ltd 77s91 101 0 A 400