HomeMy Public PortalAbout5622 ALESSANDRO AVE_Sewer__ U /
10 63
76A642D APPLICATION FOR PERMIT
6A64ll
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE County Engineer ADDRESS
WILLIAM A JENSEN Sup t of Building
LOCAL TY
NEAREST
FOIJ APPIUCAN7 T9 FILL / CROSS ST
LEGAL le
DESCRIPTION LOT NO OWNER
1 I MAIL
BLOCK TRACT ADD*S
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS //� BK PG
CONTRACTOR • 6�1
0ea,61 4441
ADDRESS CONNECTION DATA
STATION DEPTH
CITY EL NO
F��--I/'`^'ATE UPPER
REGISTRATION NO /2 �J COUNTY MANHOLE REFERENCE � c
NO DESCRIP O OF WORK FEE TYPE OF CONNECTIONLENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L r
PUBLIC SEWER @ $5 00 PC NO CL
0
SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO
PITS AND/OR DRAINFIELD @ $1000 1/A6V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @4 $3 00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER e�SEM[Nt RECORD INSTR NO DATE O
WORK TO HOUSE SEWER @ $300 ~
U
OVERFLOW SEEPAGE PIT DRAINFIELD W
EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 0.
N
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT $ 21 00
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DAT, INSPECTORS SIGNATURE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWERV'{` �'� '✓"
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
LOF
IDE IN THE ABOVE DESCRI ED �KENTIAL PROPER T ABANDON HOUSE SEWER
NATURE BACKFILL SEPTIC TANKS ❑
PERMITTEE
RESIDE
PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT A WOOD
SUPERVISING MECHANICAL ENGINEER
CK M O CASH
L"1 9 8 7ZS JM30 1 0 D 7.00
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