HomeMy Public PortalAbout5542 ALESSANDRO AVE_Sewer__ 76A
E-663 11.55 APPLICATION FOR PERMIT 1
3&E-66
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS p � tp
® CASSATT D. GRIFFIN, SUPT OF BUILDING - LOCALITY p
FOR APPLICANT TO FILL IN CROSS T.
LEGAL OWNER
DESCRIPTION LOT NO.
` ' �— �- MAIL
BLOCK TRACT ADDRESS '
( - NO. OF BLDGS. CITY ' TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF'
BUILDINGSA DISTRICT NO. GROUP MAP
BK J PG
CONTRACT J—
CONNECTION DATA /
AD SS`�
CITY a s� G TEL. N0. STATION �� DEPTH
MANHOLE REFERENCE �`
�/ ❑ STATE tj . �/✓ 1G1�
REGISTRATION NO. 7 7 ❑ COUNTY
.No DESCRIPTION OFF WORk FEE
TYPE OF CTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELDi / P. C. N0,
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. i, tZy JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 s TRUNK PERMIT NO. ROAD PERMIT N0. .VD
r CONNECT ADDITIONAL BLDG.OR ,}� STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 y - PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'SPERMIT $ 0
0
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
x TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR .J ® BUILDING OR WORK
-•1 ,.,/ I� . `+f�,
OWNERS AGENT.tb'�4"'
I' SEPTIC TANK,SEEP,PIT(S)
ADDRESS l� J AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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 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 S ATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I THE LEGAL OWNER OF T ABOVE �i !
DXCRIBEjYRESIDENTIAL OPERTY. BACOLKFILL SEPTIC TANKS❑ i w
G
SEEP.PIT(S) [_1CESSPOS �;F,�
E
JOHN A. UbeMBIE, COUNTY ENGINEER ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N.O. CASH
5 .3 �, FEB 2 n -4 5.5 0 In