HomeMy Public PortalAbout6019 ALESSANDRO AVE_Sewer__ (1
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5&E 889 3 57 APPLICATION- FOR PERMIT
886
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Depoxtnsent of County Engmeer
County of LOS Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS u (sem(
M CASSATT D GRIFFIN SUP T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST �y
-/[� / CROSS STLEGL
DESCRIPTION LOT NO 3 G G Al sa'% /���-D�'j OWNER C (�
BLOCK TRACT Gj r MAIL
ADDRESS y
SIZE OF LOT-ro J ZtJ NO OF BL -Q
NOW ON LOT
C[TY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP
EK PG
CONTRACTOR )7t,C, �- G /-5-
ADDRESSd4WA-A, CONNECTION DATA
CITY TEL NO STATION 6 f"' v ✓� DEPTH D
O/ ❑ STATE MANHOLE REFERENCE //�/v (� LUOPPER
REGISTRATION NO
❑ COUNTY '7" \J
NO DESCRIPTION OF WORK FEE
TYPE 0 URBCONNECTION LENGTH LO
POM e
HOUSE SEWER CONNECTING TO 'elle
PUBLIC SEWER Q $ 3 50 7
HOUSE SFWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 _
CONNECT ADDITIONAL BLDG OR /�j P C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO /i JOB NO
ALTER OR REPAIR EXISTING
SEWER OR D SPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PER? IT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT N0
SEPTIC TANY SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
OWNER S PERMIT $ 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE Ll if o REIMBURSEMENT FEE
IHAVE MED CON
TRACTORTOCONNECT DATE THE ABOVE CTED WDESCRBEDITH THE H EXISTING EREIN A DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS DAY OF 19- �4 C ^
OWNER ORl CONNECT ADDITIONAL
OWNERS AGENT1 �� BUILDING OR WORK
p� GIJ�.e7i� SEPTIC TANK SEEP PIT(S)
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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J FOX COUNTY ENGINEER VALIDATION R A WOOD CHIEF PLBG INSPECTOR
tCo 3 3 8 OCT 1 > 4 4 5
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