HomeMy Public PortalAbout9021 ACASO DR_Sewer_7/18/1957_sewer connection D
S&Wi6h8�11-555 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
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOB APPLICANT JO FILJI IN Ross
LEGAL
DESCRIPTION OT N0. OWNER r
BLOCK TRACT MAILADDRESS
NOF BLCITY ~ TEL. N
' SIZE OF LOT NOO W ON LOTT
USE OF
BUILDINGS "—TTM'. R0 4 BK MAP PG
CONTRACTOR
CONNECTION DATA M 77
��. ADDRESS J
.` CITY ~—' TE N STATION DEPTH
MANHOLE REFERENCE/y�
�J ❑ STATE o C/
REGISTRATION NO. �S�C/ / ❑ COUNTY
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM P ��
HOUSE SEWER CONNECTING TOY: CURB P.L. MI. .t�C
'Trt,
PUBLIC SEWER @ $3.50 6) -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00 °
OVERFLOW SEEPAGE PIT, DRAINFIELD r CO. IMP. N0. 7 JOB NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $ 2.00 m
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR " STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00, PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE 'INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 ., WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE ® ';
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON. APPROVALS DATE INSP CTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC S ER. NEW HOUSE SEWER
_
SIGNED THIS DAY F 19A�r
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG NT SEPTIC TANK,SEEP,PIT(S)
ADDRESS QU—XAND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL ElAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
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 h,
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 RESIDENTIA OPER Y. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY NGIN^EER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.O. ,4:;� --