HomeMy Public PortalAbout5807 ALESSANDRO AVE_Sewer__ CE808a58 APPLICATION FOR PERMIT - F1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF CLCo:unty
GINEER
BUILDING AND SSION BUILD NG
JOHN A LAMBIEmeer ADDRE S - �-
CASSATP D GRIFFINildum LOCAL
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL I / /
DESCRIPTION LOT NO (O , J D OWNER
BLOCK TRACTMAIL
p/ �j I A DRESS I
NO
SIZE OF LOT TU NOWOON LOT 5 U , CITY MiTEL NO V t
USE OF tm
BUILDINGS DISTRICT0 GROUP �K PPG PROCESSED BY
CONTRACTOR ^vw6
ADDRESS 1� ��- CONNECTION DATA
CITYTEL NO A P &0' 0� STATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO COUNTY LOWER
NO DESCRIPTIO OF RK 1 FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $3 00 TYPE OF ION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TOP L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO / P 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 1
CHARGES
OWNER S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE :j"06 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS v vD_ATwE� INSPECTOR 5 SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE7 -
SIGNED THISDAY OF J NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL _
OWNERS AGENT
SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COIAPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORLABA
CT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFHOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGA NER OF THE ABOVEDESCRIBED RESIDEN PROp�R�[ /' SEPTIC TANKS❑SIGNATURE
�`� ' S CESSPOOLS
OF PERMITTE
®e P VALIDATIO)I-----, ROBERT A WOOD
OK M 0 1 CA59 SUPERVISING MECHANICAL,ENGINEER
SCO 7 7 9 1 °> ,JJ11 10 1 0 A 500
Y �'