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HomeMy Public PortalAbout5406 BALDWIN AVE_Sewer__ (2) 042D CE8APPLICATION FOR PERMIT ceeos s-sa COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADORE rj/© �+ ��0/'0" At JOAN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Sup't of Building LOCALITY NEAREST e ` FOR APPLICANT TO FILL IN cgoss sr. /'°) J J / - - -. ----------. LEGAL �J( t• UC, L� , , C>' K^ O ✓ DESCRIPTION LOT N0. 3 1S �j'J+ OWNER / 7L BLOCK TRACTJ ��"'"+''� • / MAIL .�7 �i..d ADDRESS / :2 P fj NO.OF BLDGS. / SIZE OF LOT -, X/JS NOW ON LOT CITY A /'50'/t90A TEL. NO.4-4 /L$ USE OF /� BUILDINGS C dA4A.#` DISTRICT NO. GROUPPI �B7K MAP PG PROCESSED BY N CONTRACTOR >1,JZ , r It / / ADDRESS� '7 / 'c S h CONNECTION DATA CITY r2 TEL.N0.®J(, �Zl/t/ �S I DEPTH ATE MANHOLE REFERENCE / REGISTRATION NO. / 7.7 Q o (y 5/ �.� COUNTY SLOq((l l NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 '7 �-' L TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. ITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. _ PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. jN, JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PER/T N0. OAD PERMIT NO. _ WORK TO HOUSE SEWER @ $1.00 ALTER. REPAIR OR ABANDON HOUSE STATE E ROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT 0. INDU RIAL ..fir WA APP 2::? CHARG OWNERS PERMIT 2 00 CON TION CHAItsI�FEE AUTHORIZATION TOTAL FEE 'c~. 0 O REIMBURS NT FEE '1' 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPRO ,6LS DATE INSPEC 'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19- NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL o OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �.y 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 1 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 1 AM THE LEGAL 0. NER OF THE ABOVE DESCRIBED RESIDENTI PROPERTY. ) - BACKFILL SEPTIC TANKS SIGNATURE [3SEEP.PIT(S) [_1CESSPOOLS El OF PERMITTE =h.&A=.2A 1; Of VALIDCASA, ROBERT WOOD 0. CK. y.O. CASH SUPERVISING MECHANICAL ENGINEER