HomeMy Public PortalAbout5760 ALESSANDRO AVE_Sewer__ t
76A �42G - CE808 - 9/73 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING Y-7/ !.
ADDRESS V V
LOCALITY I,G 1 Z C IT
FOR APPLICANT TO FILL IN 75-0
� CROSSSTLEGAL
DESCR IP
LOT NO �0{ (J OWNER j,,�y 9� 0
MAIL
BLOCK TRACT S� ADDRESS /
NO OV BLOGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS
SK p
CONTRACTOR �, V� / Z_
ADDRESS �.d CONNECTION DATA
CITY TEL NO STATION , .1L DEPTH
STATE LIC MANHOLE REFERENCE j LOWER
LICENSE NO CLASS �c.. LOW
NO I DESCRIPTION OF WORK FEE TYPE OFC CTION LENGTH FROM O
HOUSE SEWER CONNECTING TO Y CURB PL ML TOP L
PUBLIC SEWER @ $7 00
SEPTIC TANK SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD @ $1000 CO IMP NO 3 JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVE EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER ® $300 R
OVERFLOW SEEPAGE PIT ORAINFIELD C7
EXTN CESSPOOL DRYWELL @ $500 C�
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT CD
MANHOLE $7 00 PERMIT NO is INDUSTRIAL LLId
WASTE APPROVAL N
Z
OWER
NS PERMIT E 3 00 CHARGES
AUTHORIZATION TOTAL FEE 0 0 CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS t
BUILDING OR WORK 9-o 7 2l,9 ."2q2'j
SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DR.$INFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS I CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFC,RN IA OR THAT I AM THE EGAL O NER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE S I CD? IAL PR ERTY ABANDON HOUSE SEWER
SIGNATURE �` BACKFILL SE
OF PER MTTTEE SEEP PIT(S)PTIC C�E S O❑LS ❑
VALIDATION CK M 0 CASH
2 73'EnAUG ?_610 0 600 ®�
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