HomeMy Public PortalAbout6009 ALESSANDRO AVE_Sewer__ n
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CE808 a as APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION _ BUILDING
JOHN A IAMBIE County Engineer ADDRESS 7
CASSATT D GRIFFIN Sup t of Builchng LOCALITY
NEAREST
FOR APPLICANTTO FII.L IN CROSS ST
LEGAL <
DESCRIPTION LOT NO �' OWNER
BLOCK TRACT MAIL
ADDRESS
0 OF BL-G8
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGSDISTRICT NO GROUP MAP P CESSED BY
BK
CONTRACTOR }
(r bf
ADDRESS CONNECTION DATA
CITY:' NO / STATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO � COUNTY LOWER
NO DESCRIPTION OF WORK FEE
HOUSPUBICSEWER
SEWR
EECONNECTING TO @ $y 00 )p
SEPTIC TANK SEEPAGE PIT OR TYPE OF C CTION` LENGTHFROM
PITS AND/OR DRAINFIELD Q $S 00 Y P L M L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TOP C NO
PRIVATE DISPOSAL SYSTEM a $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER Q $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 PERM S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 1,61 oo 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
SIGNED THIS DAY OF /72SO 1942 NEW HOUSE SEWER — u
OWNER OR �� �� BUIL ING ORNECT WORK
_
OWNERS AGEN
SEPTIC TANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
ACKNOVhEDGETHIS APPLICATION
ANHEREBY STATE THAT THE ABOVEHIS CORRECTTl HAVER
DEAD
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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
LDESCRIBED
IFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
RESIDENT OPERTY BACKFILL SEPTIC TANKS❑ �[� ¢� fi11I�1J'
ATURE SEEP PIT S) ❑ CESSPOOLS
PERMITTE Z
®� MMATION ROBERT A WOOD
III p CAgg SUPERVISING MECHANICAL ENGINEER
4 LiC G 7 8-8 FL 30 A 6 00 �