HomeMy Public PortalAbout5606 ALESSANDRO AVE_Sewer__ &E-669 11.55
5&E- APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles G
JOHN A. LAMBIE, COUNTY ENGINEER —ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
_ OI� APPLICANT TO FILL IN CROSS ST.
L L ����/\ OWNER IV
DE IP A T N0. -`
MAIL
K TRA ADDRESS
NO.OF BLDGS. I CI TEL. NO 41 IV
SIZ NOW ON LOT
USEF
B U I L INGS DISTRICT NO. GROUP MAP
al BK PG
1
CONTRACTOR 7 �7� 3
ADDRESS CONNECTION DATA
CITY AOL +.. C TEL. NO.t' U' r 1 5/AIDN ,�j � LJ DEPTH L
MANHOLE REFERENCE UPPER
_ �BTATE LOWER
REGISTRATION NO. 2 1 ❑ COUNTY
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION 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,DRAINFIELD /�/ r� P. C. N0.
EXTN.,CESS POOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO.( (` 1OB N0.
HOUSE SEWER CONNECTING TO O
PRIVATE DISPOSAL SYSTEM t@ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Qn $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE 1 5 jL3 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ _ APPROVALS D TE INSPECTO 'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER r
SIGNED THIS
/D 19 CONNECT ADDITIONAL
OWNER OR /�r�V/5 � BUILDING OR WORK
OWNERS AGEN �� ' YYy
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL❑
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 LDS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT /_A THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAERTY. r BACKFILL SEPTIC TANKS ElSIGNATUREPIT(S) CES OOLS ElOF PERMITTE6 /
JOHN A. LAMBIE, CO NTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
1 !1. 0. CASH
VV���� Go63zD su25 4 4.50 in