HomeMy Public PortalAbout5426 ACACIA ST_Sewer_9/14/1965_saddle CEEDE 3 E4 -- APPLICA
7EAE420 TIO FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, County Engineer ADDRESS
WILLIAM A JENSEN, Supt of Building
LOCALITYNEARE
CROSS
FOR APPLICANT TO FILL IN
LEGAL O f`
DESCRIPTION LOT NO ' OWNER r
MAIL
BLOCK TRACT ADDRESS
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDING � � DISTRICT NO GROUP MAP PROCESSED BY
sr P
CONTRACTORel Ir e K PG
ADDRESS
/f (' t 4099:7 , CONNECTION DATA J
CITY L ATIONr DEPTH
�) STATE MANHOLE REFERENCE /j UPPER
REGISTRATION NO v B COUNTY �(� LOWER
NO DESCRIPTION OF WORK FEE TYPE OFCO N LENGTH FOM
HOUSE SEWER CONNECTING TO Y ,. FL
OM
L M L TO P L
PUBLIC SEWER $500 PC NO
SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO d.
PITS AND/OR GRAINFIELD 51000
O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM $300 91-2 e2 In
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVES i EASEMENT RECORD INSTR NO DATE 0.
WORK TO HOUSE SEWER S300 O
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE GI $500
ALTER REPAIR OR ABANDON HOUSE HWY 2&mulil
SEWER OR DISPOSAL $300 STATE ENCROACHMENT
L PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERSPERMIT $ CHARGES A
AUTHORIZATION TOTAL FEE L CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF —19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT z CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL Cl DRYWELL ❑
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS R UIRED BY LOS ANGLES COUNT AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIAHE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN Hjq �.A�OV. DMEJC RIBED DENTIAL RAND
ABANDON HOUSE SEWER
SIG NATUR BACKFILL SEPTIC TANKS ❑
OF PERM SEEP PIT(S) ❑ CESSPOOLS ❑
LIDATI ROBERT A WOOD
-M o cnsH SUPERVISING MECHANICAL ENGINEER
L,�L0 5 5 6 6Q SE° 1 4 1 1 D 2 5.00-