HomeMy Public PortalAbout5009AGNES AVE_Sewer (2) &E 6D
8 88 11 53
APPLICATION FOR PERMIT
1
&E 8
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engmeer
t County of Los Angeles ADDRE Mo
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JOHN A LAMBIE COUNTY ENGINEER
CASSATT D GRIFFIN SUP T OF BUILDING LOCAL— 1��AA /j! rr
FOR APPLICANT TO FILL IN CROSS ST Jgd' ' q
LEGAL I 1 OWNER N ! NIS
DESCRIPTION LOT NO E
BLOCK TRACT AI& J� 77 C'L' `F ADDRESS ,j��� _9"Al A(} � � v ,
SIZE OF LOT <QO SO NNO OF BLDG ;MOW ON LOTSQF �' r L CITYT t T`ELL NNO_� ���ffF 430
USE OF
BUILDINGS 41 DISTR[C NO GROUP MAP
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BK PG
CONTRACTOR ,y ® -16
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ADDRESS
CONNECTION DATA
q7 �'' O STATION / DEPTH
CITY q�STEL
MANHOLE FERENCE( � UPPER
fde— ❑ STATE
REGISTRATION NO nn ❑ COUNTY
NO DESCRIPTION OF WOFfK 1,, E
HOUSE SEWER CONNECTING TO YPE OF TION LENGTH FROM
PUBLIC SEWER $3 50 ® Y CURB P L M L TO P L s
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00 \\
OVERFLOW SEEPAGE PIT DRAIN ELD P C
EXTN CESSPOOL DRYWELL MA OLE @ $2 00 CO IMP NO JOB�NO
HOUSES EWER CONNECTING r
PRIV TE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD P RMIT N Oje t
CONNECT ADDITIONAL BL OR STATE ENCROACHMENT a /�
WORK TO HOUSE SEWER @ $1 00 PERMIT NOt1
ALTER REPAIR OR ABA DON HOUSE INDUSTRIAL
SEWER OR DISPOSAL STEM @ $100 WASTE APPROVAL "
CHILRGES
CONNECT CHARGE &E
OWNERY PERMIT $ 1 00
REIM RSEMENT FEE
AUTHORIZATION TOTAL FEE ��yy ,I
1 HAVE AT THIS DATE A CONTRACT WITH THE HE REI NAMED CON APPR S DATE NPS ECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST NG DWELLING
TO THE PUBLIC SEWER NEW HOUSE WER
SIGNED THIS. 14 DAY 0 Ttl q T(`/19 CONNECT A ITIONAL
OWNER OR BUILDING WORK
OWNERS AGENT ,a SEPTIC TA SEEP PI S)
ADDRESS /`Y AND/OR D INFIELD ,� X
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL ' DRYWELL 5
' Et` (}_
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER Of
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEQN
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND §TATE OF ABANDON HOUSES WER
CALIFORNIA OR THAT I AM THE LEG NER OF T E ABOVE
DESCRIBED RESIDENTIAL OPER BACKFILL SEPTI NKS
SIGNATURE
SEEP PIT(S) C SPOOLS❑
OF PERMITTEE � �/ J
JOHN A LAMBIE COUNTY ENGINEER VAL ATION UF2
A WOOD CHIEF PLBG IN ECTOR
CK M O CA H
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