HomeMy Public PortalAbout9021 ACASO DR_Sewer_8/20/1957_sewer or disposal system E-663 it•SS
S&EAPPLICATION FOR PERMIT 7
8 8:E•6 �®4
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, SUP'T OF BUILDING ,: LOCALITY �.
FOR APPLICANT TO FILL IN CROSS sr.
DESCRLEGIPTION LOT No. j�e �,/ SEC,
L I OWNER f7
MA
BLOCK TRACT S r %� ADDRESS 'O A I CJC V
NO.OF BLDG ! CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS PGS
CONTRACTOR r ,y
ADDRESS
CONNECTION DATA
� ,/`�
STATION DEPTH
CIT TEL. N0. MAN E REFERENCE OPPER
❑ STATE - LOWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE 0 ONNECTION LENG FROM
PUBLIC SEWER @ $3.50 Y. B P.L. M. 0 P.L.
SEPTIC TANK,SEEPAGE PIT OR.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 '- CO. IMP, N0. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. D PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROA ENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO. -
AIXEfL-REa#iR-OR ABANDON HOUSE ,p �q INDUSTRJXf
SEWER OR DISPOSAL SYSTEM ,@ $1.00 ( Ci WASTE PPROVAL
;a
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEEla' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. 4 APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR.WORK -
OWNERS AGENT 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 ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 A THE LECyqL 0 R OF THE ABOVE y)
DESCRIBED RESIDENT P PERTY,�// BACKFILL SEPTIC TANKS❑
IGNATURE � � SEEP.PITS) ❑ CESSPOOLS �{:� ! !
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M.O. CASH
;` 1' 3. 5 0�;; AUG20 4 2.00 M
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