HomeMy Public PortalAbout6018 ALESSANDRO AVE_Sewer__ E-6D
S& 63 11-55
APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS7 ,
JOHN A. LAMBIE, COUNTY ENGINEER t+ �� -y 4 s •l
I' ® CASSATT D. GRIFFIN, SUPT of BUILDING L ^
LOCALITY " �
FOR APPLIrC•7ANT TO FILL IN
NEAREST.
LEGAL S _ OWNER
DESCRIPTION LOT N0. V
MAIL
BLOCK TRACT ` �' ADDRESS 3' f•w
LDGS. CITY .}'+ f TEL. NO.
SIZE OF LOT ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS
BK PG
1__ ) 51
CONTRACTOR -7
ADDRESS 7e
�:� • CONNECTION DATA
4111
10
CITY L. NO. - STATION DEPTH '--
" MANHOLE REFERENCE /)D� �CS� UPPER
"'? �� � � ❑ STATE pC
REGISTRATION N0. Ste * El COUNTY
No. DESCRIPTION OF WORK FEV F,• TYPE OF OMIMCTION LENGTH FROM .
HOUSE SEWER CONNECTING TO S sO Y. (CURB) P.L. M.L.TO P.L. ��
.
PUBLIC SEWER @ $3.50 3
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
i
_ EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. 106 NO.
I HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM n $1.00 _TRUNK PERMIT NO. ROAD PERMIT N0. /
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
I
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
S6
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY,OF 19 ` ' CONNECT ADDITIONAL T
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ---CES __ _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 I AM THE LEGAL 0 OF THE ABOVE
DESCRIBED RESIDENTIAL PRO E�TY. BACKFILL SEPTIC TANKS❑
SIGNATURE 01P __SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGIEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M. 0. CASH
4.5
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