HomeMy Public PortalAbout5709 ALESSANDRO AVE_Sewer__ l
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76AB42D APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FN�EAREST
JOHN A LAMSIE County Engineer `� 1 / D /SSS r1 yLC1^B
WILLIAM A JENSEN Sup t of Building /J r�
; 2/�Yf
�L.o,vow a
F R LI T TO FILL IN CROSS 5T
LEGAL � /
DESCRIPTION LOT NO OWNER A✓,
MAIL S
BLOCK TRACT ADDRESS S!QVo /Mees s
NO6F BL G5
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GTj MAP PROCESSED BY
BUILDINGS
BK PG
CONTRACTOR 17/O/z/s�I51/1/S 0/46 � U r/ z75ADDRESS 316 � `( � /1, CONNECTION DATA �C
CITY�SC(Jf � 46.1.1 Q, TEL NO A �7�j ,s �^ STATION �L_ DEPTH �
❑ STATE MANHOLE REFERENCE r
REGISTRATION NO ❑ COUNTY ` OWER
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 @ $5 00
SEPTIC TANK SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD @ SIO 00 CO IMP NO JOB NO U
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD T NO
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT ORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300 �—
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ 55 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENI
SEWER OR DISPOSAL SYSTEM @ E3 00 STATE ENCROAC ENT
PERMIT NO
INDUSTRI
WASTE ROVAL
OWNERS PERMIT $ z 00 f z
CHARGES
AUTHORIZATION TOTAL FEE ! CONNECTION CHARGE FEE
1HAVE 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 DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK SEEP PIT(S) ! r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAI NFIELD 1
AND SALE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WIT ALL�COUNTY ORDTt�P INCE-AYa6'-STATEy"'iSLAWS-REGUrATI11G-
PLU BING AND SEEN ERS •.`- b a 1 ESSPOOL [:1DRYWELL ❑
1 HEREBY}CERTIFY>frH tT I A1713PROPERLY REGISTERED AND/OR LTER REPAIR SEWER OR
LICENSED AS REQUIRED BN LOS ANGLES COUNTY AND.STATE OF SWAGE DISPOSAL SYSTEM
CALLFO�Ra.NIA^OR THAT I AM THE LEGAL OW NE$,rOF;AND INTEND"TO ib ISCON NECT PLUG AND
1rRE51O FIi�--4}FF`>�0.f3�OY A.. 'y`f^Lbf _31IlENTtALZ:PRA^R7.Y : I�gANDON HOUSE SEWER
-_R9TATE LAWS IRU TING SUI NG NSTRUCION
31GNATURE Ofs r ) O FILL SEPTIC TANKS ❑
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'bPE MITTfi • . EEP PITS) El CESSPOOLS C]�an �MfROBERT A WOOD
[%' t�: '
ADDRESS ° h4Y I ON
SUPERVISING MECHANICAL ENGINEER
CASH
ui�� 1 1 4 5 0 FEB 2 0 1 0 D 500* �'