HomeMy Public PortalAbout4808ALESSANDRO AVE_Sewer f
-B,
76A6423-61
APPLICATION FOR PES IT
6A642
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_ LOCALITY /
NEAREST
FOR APPLICANT TO FILL IN CROSS sr.
DESCRIGPTION LOT N0.AL 0'l(j G 7/�� tS OWNER
BLOCK TRACT .zMAIL
D /�h!t ADDRESS
PIO.OF BLDG
SIZE OF LOT - d / �J NOW ON OTS / CITY TEL. NO.
USE OF
BUILDINGS G� DISTRICT NO GROUP MAP PROC ED BY
!.i
��
CONTRACTOR BK PG i
/ - S' J
ADDRESS CONNECTION DATA
CITY TEL. STATION DEPTH
STATE UPPER
REGISTRATION NO. ® COUNTY MANHOLE REFERENCE LOWER
NO. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC
PITS AND%OR DRAT NK,SEEFGELDIT OR @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ 52.00
HOUSE SEWER CONNECTING TO P.C.NO. 0
O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. V
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ 51.00 TRUNK PERMIT N0. ROAD PERMIT N0.
O
ALTER,REPAIR O R A SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT F-
SEWERPERMIT N0. V
w
INDUSTRIAL CL
N
WASTE APPROVAL
CHARGES
ow
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE /,57�O
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
DATE A CONTRACT WITH THE HEEIN NAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIST NG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OR 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE 'THAT C HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
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 DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE L PROPERTY BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S ❑ CESSPOOLS
OF PERMITTEE-
YAMATION ROBERT A. WOOD
fid' u ✓.� CK. M.0. use SUPERVISING MECHANICAL ENGINEER
M56 .fir NOV 30810450.00AM