HomeMy Public PortalAbout5538 ALESSANDRO AVE_Sewer__ 76A6420
663 11 89
8 APPLICATION FOR PERMIT 1
&E 88
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engmeer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST c-"
LEGALS Y6 �! IV pfd r6-J.& jro
DESCRIPTION LOT N V OWNER �,/j^�� � ,�
BLOCK TRACT r ADDRESS
NO O
SIZE OF LOT
G� I O NOW ON LOTS , CITY , TEL NO �'tb���4
USE OF DISTRICT NO GROUP MAP
BUILDINGS =.Y..� I 7- I G
CONTRACTOR aw v �C� Qy`
ADDRESS SO,So /,r/el CONNECTION DATA
CITY �( y� i�v STATION JL_ � —5—i DEPTH
TEL NO MANHOLE RE NCE UPPER
XA' STATE LOWER
REGISTRATION NO V 4 L ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF TION LENGTH FROM
HOUSE SEWER CONNECTING TO ,` Y URB P L M L TO P L
PUBLIC SEWER @ $3 50 J
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00 —
OVERFLOW SEEPAGE PIT DRAINFIELD � 2 / P C NO
EXTN CESSPOOL DRYWELL MANHOLE Q $ 2 00 CO IMP NO (P JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $100 TRUNK PERMIT NO ROAD PERMIT NO p(
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT g 1 00
AUTHORIZATION I TOTAL FEE -5`0 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO THE PUBLIC SEW NEW HOUSE SEWER
i
SIGNED THIS Y OF n Iva 4e 19 CONNECT ADDITIONAL
OWNER OR ` BUILDING OR WORK
OWNERS AGENT SEPTICTANK SEEP PIT(S)
ADDRESS - 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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWCRS 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 RESIDENTIAL PROPERTY ` q' /� '" BACKFILL SEPTIC TANKS❑
SI /�: /�•l-�C�ce`Yc.p SEEP PITLl CESSPOOLS_CESSPOOLS �
OF PERMITTEE ��y--- -tL_ +
L
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK 11 O CASH
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