HomeMy Public PortalAbout5223ALESSANDRO AVE_Sewer E808 D
CAPPLICATION FOR PERMIT
I>sos a as COUNTY OF LOS ANGELES �.
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. I:AMBIE County F7ngmeer ADDRESS
CASSATT D GRIFFIN Sup t of Buildmg LOCALITY
NEAREST
FOR APPLICANT TO FELL IN CROSS ST yZee
LEGAL t /
DESCRIPTION LOT NO r.O � OWNER
BLOCK TRACT MAIL
�Y ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT =� CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
BK PG
CONTRACTOR
ADDRESS f CONNECTION DATA
CITY (l`/` TEL NO �T STATION Y DEPTH
ll� STATE MANHOLE REFERENCE UPPEW
REGISTRATION NO �O �Y COUNTY to g, LOWER
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00
SEPTIC TANK SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y CURB P L M L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD /
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR _ TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
EWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO
d INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PMUTT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE lov REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS oAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
LABANDON
TANK SEEP PIT(S)
ADDRESS DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYL❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGREPAIR SEWER OR
PLUMBING AND SEWERS DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFN HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL\OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY L SEPTIC TANKS❑
TS ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
06 1
®P VALIDATION ROBERT A WOOD
f CK Ill CASH SUPERVISING MECHANICAL ENGINEER
[ ,T09 1 0 7 JUL 1 1 A 2500 kn