HomeMy Public PortalAbout5939, 5939 1/2 ALESSANDRO AVE_Sewer__ H808 c Boa B EB nPLD ATION FOR PERMIT ` 1
COUNTY OF LOS ANGELES S EWE Rs S EWA( E DISPOSAL
DEPARTIAM OF COUNTY ENGINEER,t
BUMDING AND SAFETY DMSION BUILDINMBBUILDING LL
JOHN A LAIE County Fmgmeer 4 �y�
CASSAT! D GRIFFIN Supt of Building LOCALITY U&�RP�
NEAREST /
FOR APPLICANT TO FILL IN ceosS ST
LEGAL `` 'rDESCRIPTION LOT NO,-� OWNER
J
BLOCK TRACT r - MAIL
( I ADDRESS
NO OF BLDGS
SIZE OF LOT x NOW ON LOT CITY TEL NO
USE OF I MEN=
BUILDINGS DISTRICT NO GR/OUP MAP ROCESSED BY
CONTRACTOR � p f BK PG
ADDRESS "—' CONNECTION DATAALI
l/
CITY TEL NO lj O STATION DEPTH
REGISTRATION NO Q COUNTY
STATE MANHOLE REFERENCE UPPER
No DESCRIPTION OF WORK FEE r LOWERHOUSE SEWER _
PUBS C SEWER CONNECTING TO $8 00
SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD 0 $S 00 1 Y CURB P L r M L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR r ��
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
/
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
-OWNER S PE WT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION LTOTAL FEE -3 0-0 REIMBURSEMENT FEE
4O 6G� CI3P
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
SIGNED THIS-------DAY OF i9— NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
��� /
OWNERS AGENT BUILDING OR WORK Ztr�a
` SEPTIC TANK 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 COMPLY 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/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) El CESSPOOLS
OF PERMITTE
Or VALIDATIO ROBERT A WOOD
m y p CAsIt SUPSRYISINC3 MECHANICAL ENGINH6R
a LACfl 3 9 b 8 �S JUL 0 1 0 3 0 0