HomeMy Public PortalAbout5239 BALDWIN AVE_Sewer__ (2) 97 93
c 808.D APPLICATION FOR PERMIT
esoa•e•sa COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS - - -:r
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CASSATT D. GRIFFIN, Sup'( of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL ee
DESCRIPTION LOT N0. OWNER
BLOCK TRACT MAIL
ADDRESS A�
'�
Z) NO.OF BLDGS.
SIZE OF LOT &v ,( -x,17 NOW ON OT CITY ,P TEL.NO
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CON.TRACTO V %6 'e-
ADDRESS-1: — —
ADDRESS •_ 'v _ CONNECTION DATA
CITYL4y:22QndA, TEL. 0. STATION �,vt� DEPTH
STATE 6 0 � UPPER.
REGISTRATION N0. (] COUNTY MANHOLE REFERENCE� 6
NO. DESCRIPTION OF WORK FEE LOWER
/
HOUSE SEWER CONNECTING TO - Y
PUBLIC SEWER @ $3.00 YPE OF CONNECTION LENGTH FROM
PITS ANPTIC D%OR"DRAINFGELDIT OR @ $3.00 Y. CURB P.L. 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. /°6' JOB N0.
CONNECT ADDITIONAL B TRUNK PERMIT N0. ROAD PERMIT NO.�� �Ced�
WORK C HOUSE SEWER OR, 0 /
AER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWLTER OR DISPOSAL SYSTEM @ $1.00 _PERMIT NO.
INDUSTRIAL
_WASTE APPROVAL
CHARGES
Oymgg PERMIT S 2 CC CONNECTION CHARGE FEE
AUTHORIZATION ITOTAL FEE 4ry REIMBURSEMENT FEE
( 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. i
SIGNED THISCDA OF J 9 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AG EN / ✓�' � � d�/ ' BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STskTE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF T -E ABOVE
DESCRIBED RESID 1 P ERTY. BACKFILL SEPTIC TANKS [I
SIGNATURE A"..v 2 SEEP. PIT(S) El CESSPOOLS OV F
OF PERMIT t
�s
6rALMATION ROBERT A.WOOD
H.
Q.
c"H SUPERVISING MECHANICAL ENGINEER
1