HomeMy Public PortalAbout5623 ALESSANDRO AVE_Sewer__ 1 I
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76A642D80 t APP I C •TIO FOR PER M I T
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
ADDRESS (p
JOHN A LAMBIE County En weer e
WILLIAM A JENSEN Sup t of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL 1 4 , K
DESCRIPTION LOT NO 0 OWNER r
BLOCK TRACTat MAIL
ADDRESS
NO OFBLDGS T '?J4'06 j l
SIZE OF LOT NOW ON LOT CITY TEL NO / OV
USE OF
BUILDINGS Q4 0- DISTRICT NO GROUP HK PG- t MAP ROCES BY
CONTRACTOR I 3
ADDRESS CONNECTION DATA
CITY TEL NO ATZ 72 /2STATION O O DEPTH
REGISTRATION NO O 5 COUNTY MANHOLE STATE REFERENCE �S UPPER
No DESCRIPTION OF WORK FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ Wair TYPE 0 CTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR ,Y CURB P L M L TO P L
PITS AND/OR DRAINFIELD @ S 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ 00
PRIVATE DVER ISPOSAIL SYSTEM ING TO @ 1 00 CO IMP NO/ Z Z JOB NO
WORK CT ADDITIONAL BLDG OR @ I OO TRUNK PERMIT NO ROAD PERMIT NO D O
U
ALTER REPAIR OR ABANDON SEWER OR DISPOSAL SYSTEM HOUSE @ I OO STATE ENCROACHMENT RI
PERMIT NO
INDUSTRIAL W
WASTE APPROVAL w
!J' o CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEW 194:2
SIGNED THIS DAY OF 194^' NEW HOUSE SEWER /
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS S"23 ` SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
t HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ 'fl, P J
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR !
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY TH AM PROPCLEGISTERED AND/ORLICENSED AS REQUIRED LOS AN ENTY AND ST E OF DISCONNECT PLUG AND
CALIFORNIA ORTHAT AM THE E AE TH ABOVE ABANDON HOUSE SEWER r
DESCRIBED RESIDEN PROPERT BACKFILL SEPTIC TANKS ❑ 7
SEEP PIT(S ❑ CESSPOOLS ❑ �Mf'
SIGNATURE
OF PERMITT
i
®P ATIOusx� ROBERT A WOOD
c H 0 SUPERVISING MECHAtNICAL ENGINEER
LAW 4 5 3 7 SEP 19 1 0 D,�
700-