HomeMy Public PortalAbout5546 ALESSANDRO AVE_Sewer__ 76A 64L/70 APPLICATION FOR PERMIT LJ,'"��
76A 642D f 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL f ''
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS i
COLEMAN W JENKINS SUP T OF BUILDING
LOCALITY `y ,� `:::✓✓✓LLL
NEAREST
F R APPLICANT TO FILL IN CROSS ST .ta
(PRINT OR PE O Y)
LEGAL
DESCRIPTION LOT NO G� OWNER
MAIL
BLOCK TRACT ADDRESS ✓ "�
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRI(CT N GROUP fL S MAP PROCESSED/} � BY
CONTRACTOR(' I V (j i/'C.�j )/ � /BK r �`i.��
ADDRESS � � �7 ''7 �l CONNECTION DATA
CIT)1 .i/� W�"� TEL NO ?J F1/ Qpm` TION DEPTH
LICENSE NO ,�I/� GSTATE LASS MANHOLE REFERENCED LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONN LENGTH FRO
HOUSE SEWER CONNECTING TOY P L M L TO P L
>iT
PUBLIC SEWER @ VV✓
SEPTIC TANK SEEPAGE PIT OR ^ C NO
J
PITS AND/OR DRAINFIELD @ 510 00 CO IMP NO OB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O�
PRIVATE DISPOSAL SYSTEM $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT *,IV,, [I15[Y[NT RECORD INSTR NO DATE O
WORK TO HOUSE SEWER @ S300 V
OVERFLOW SEEPAGE PIT DRAINFIELD w
EXTN CESSPOOL DRYWELL MANHOLE @ $S 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING O
SEWER OR DISPOSAL SYSTEM @ $3 00 ~
STATE ENCROACHMENT u
PERMIT NO W
O_
INDUSTRIAL t!)
WASTE APPROVAL Z
OWNER S PERMIT S 00 CHARGES
lfv AUTHORIZATION TOTAL FEECONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWR.� APPROVALS D TE INSP OR S SIGNATURE
SIGNED THIS a DAY O {,4,14 19
OWNER OR ,yf NEW HOUSE SEWER
OWNERS AGENT'` f CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH S APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CA�IFORN IA OR THAT IAM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESCRIBED RESIDENTAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE pp ❑
OF PERMfTTEBACKFILL SEPTIC TANKS
SEEP PITS) ❑ CESSPOOLS ❑
VALIDATION JACK R ALLEN
SUPERVISING MECHANICAL ENGINEER
CK M O CASH
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