HomeMy Public PortalAbout5950 ALESSANDRO AVE_Sewer__ CES08 It 57 APPLICATION FOR PERMIT
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COUNTY
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL ,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING, ��? ,] t
JOHN A LAMBIE County En meor ADDRESS h�G>
CASSATT D GRIFFIN Sup t of Bui]dmg
LOCALITY
FOR APPLICANT TO FILI. IN CROSS sj s =
LEGAL
[DESCRIPTION LOT NO �i y OWNER
LOCK TRACT MAIL
S' ADDRESS ry
NO 0 BLDGS
IZE OF LOT NOW ON LOT CITYTEL NO�r L
SE QUILDING J DISTRICT NO GROUP MAP
HK PG
ONTRACTOR mmm
DDRESS 1 CONNECTION DATA
ITY- G TEL N ¢7 STATION O DEPTH
T mmuirm
STATE MANHOLE REFERENCE - R
REGISTRATION NO �y J % 8 COUNTY
N DESCRIPTION F WORK FEE t OWER
HOUSE SEWER CONNECTING TO r
PUBLIC SEWER @ $39- e TYPE OF TION LENGTH FROM `
SEPTIC TANK SEEPAGE PIT OR Y CUR P L M L TOP L �d
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 @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR ,�'l
WORK TO HOUSE SEWER @ $1 00 CT6 TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES _
OWNER'S PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 6 d1 D REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH-THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECT R S SIG ATURE Y
TO THE PUBLIC SEWER
SIGNED THIS DAY 0 ]��_ yNEW HOUSE SEWER r YN r
OWNER OR CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
ADDRESS
_ ,..._._» .. ..SEPTIC TANK SEEP PIT(S) _
r AN0/0R DRAINFIELD
IH
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ,., t ., ;rl
AND STATE THAT THE ABOVE IS CORRECT AND AGREE-TO COMPLY- _CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES_AND STATE LAWS REGULATING
PLU s AND SEWERS ALTER REPAIR SEWER OR
I ER Y-CERTIFY THAT-I-AM-PROPERLYEGISTERED AND/OR SEWAGE DISPOSAL SYSTEM-
LI AS EQUIRED BY S ANGE S C NTY ATE OF DISCONNECT PLUG AND
CAL ORNIA THAT 1 A HE-LEGA NER,OF TH ABO E_ ABANDON HOUSE SEWER
D IBE SIDENTIAL P ERTY BACKFILL SEPTIC TANKS Cl
IfA _ TM EP PIT(S) ❑CESSPOOLS
E TT '
Or _ VALIDATIO 'ROBERT`A WOOD "
A CK M^o CASH SUPERVISING MECHANICAL ENGINEER-
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