HomeMy Public PortalAbout5757 ALESSANDRO AVE_Sewer__ r
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100C&N R PERMIT��e°8 a >sa a
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COUNTY OF LOS ANGELES „SEWER—SEWAGE ,DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING,
JOHN & LAMBIE County Engineer ADDRESS
CASSATT D GRIFFIN Sup t of Building LOCALITY
FOR APP CANT TO FILL IN CROSS ST Wo I ( N L"
LEGAL /
DESCRIPTION LOT NO OWNER
BLOCK TRACT �' 5 c50 `— MAIL
ADDRESS
SNO OF
SIZE OF LOT NOW ON LOTS CITY l lt/i TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP BK PG PROCESSED BY
CONTRACTOR Y —7
ADDRESS CONNECTION DATA
CITY TEL NO ® STATION DEPTH
STATE JdANHOLE REFERENCE UPPER
REGISTRATION NO COUNTY
NO DESCRIPTIO OF WORK EE
HOUSE SEWER CONNECTING TO .q
PUBLIC SEWER Q $8 00
SEPTIC TANK SEEPAGE PIT OR TYPE OF TION LEN GTH FROM
PITS AND/OR DRAINFIELD @ $S 00 Y CURB TH P L M L OP L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TOP C NO
PRIVATE DISPOSAL SYSTEM Q $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER �1 /r
SIGNED THIS /o DAY F J g �O NEW HOUSE SEWER ]-(��(�12
�fT �
OWNER OR CONNECT ADDITIONAL v
OWNERS AGENT 'Lv� BUILDING OR WORK
7 S QAr N SEPTIC TANK SEEP PIT(S)
ADDRES AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
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 LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT L ROPERTY BACKFILL SEPTIC TANKS❑ // �/
SIGNATURE SEEP PIT(S) CESSPOOLS
OF PERMITTor
E _
®� 'VALIDATION ROBERT A WOOD
"89 SUPERVISHiG MECHANICAL ENGINEER
07 61 3 ,cS MAR ]. 1 1 G A 500
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