HomeMy Public PortalAbout5334ALESSANDRO AVE_Sewer `�. <.331
61
76A64261
APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A, LAMBIE County Engineer ADDRESS
WILLIAM A JENSEN Sup t of Building_ LOCALITY
NEAREST _,Ot� - 71
FOR APPLICANT TO FILL IN CROSS ST
LEGAL OWNER
DESCRIPTION LOT NO
BLOCK TRACT HAIL
ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO I GR BK 8 MAP PROCESSED BY
J
r
CONTRACTOR /i O� [fJ]
7
C-,>; 9"e-,
ADDRESS CONNECTION DATA
CITYe r TEL NO 3 70 y/ 1,600" DEPTH
REGISTRATION NO / J — t;0 COUNTY MANHOLE REFERENCE 0 ' UPPE
No I DESCRIPTION OF _WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @,6-00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L H L TO P L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD }
EXTN CESSPOOL DRYWELL @ 52 00 IL
HOUSE SEWER CONNECTING TO P C NO 0
PRIVATE DISPOSAL SYSTEM @ $t 00 CO IMP NO JOB NO V
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO ' OC
WORK TO HOUSE SEWER 51 00 0
SEWER 0 EDASPO R ABAAISTEN HOUSE @, $1 00 STATE ENCROACHMENT
PERMIT NO W
INDUSTRIAL a
WASTE APPROVAL N
CHARGES ?
OWNER S PMWT S 2 LOO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEF 7 1 e_0 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19— NEW HOUSE SEWER ®/�drW2 `•�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
LDAEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
G AND SEWERS SEWAGE DISPOSAL SYSTE14
EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ED RES T AL PROP BACKFILL SEPTIC TANKSS P PITS CESSPOOLSREMITTE
ALMATION ROBERT A WOOD
dr-
n o CASH SUPERVISING MECHANICAL ENGINEER
L"5140% OCT 4 1 0 0 '7 00-
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