HomeMy Public PortalAbout9090 ACASO DR_Sewer_4/6/1956_337305 sewer connection s°aE`e 811 se - APPLI-CATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL , 1 -
Dep=tment of County Eagmeer '
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
Y
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO 1411q • ..,Q 1 OWNER '
BLOCK I
TRACT ,—14.2-1
+14 / MAIL
_% ADDRESS NO'OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE
BUILDINGS ! DISTRICT NO GROUP + MAP
( V BK PG
r
CONTRACTOR I
—y
v /� CONNECTION DATA
ADDRESS'• Ila f-� ��ev��
STATION V DEPTH �, r
CITY TEL NO MANHOLE REFERENCE. 497 HA
❑ STATE 1 W s LOWER
REGISTRAT N NO 4.3
`0 0— ❑ COUNTY
NO DESCRIPTION OF WORK FEE
TYPE OF ONN TION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L,
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR "r
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL,MANHOLE @ $•2 00 CO IMP NO 1977-7 JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR " STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO -
ALTER REPAIR OR ABANDON HOUSE y INDUSTRIAL
SEWER OR,DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL -
I
CHARGES
^ F
s CONNECTION CHARGEFEEr
OWNER'S pERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INS ECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER 01
.� lr, NEW HOUSE SEWER
LIN
SIGNED THIS - DAY OF G 10- CONNECT ADDITIONAL ,
OWNER`_-OR BUILDING OR WORK
OWNERS AGEN SEPTICTANK,SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'r^
AND STATE THAT THE ABOVE IS CORRECT,AND AGREE TO COMPLY CSSPOOL❑ 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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN
T PROPERTY BACKFILL SEPTIC TANKS El
SIGNATURE � SEEP PIT(S)❑ CESSPOOLS
OF PERMITTEE E
JOHN,A LAMBIE COUNTY ENGINEERVALIDATIO
CK cnsx ROBERT A WOOD CHIEF PLBG INSPECTOR
r _ ILA o 4 $,A APR 6 4 - AS Q v)
Y
O
1