HomeMy Public PortalAbout5550ALESSANDRO AVE_Sewer C EA 6420�0 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL Ifli
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
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JOHN A LAMBIE COUNTY ENGINEER RESS
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COLEMAN W JENKINS SUP T OF BUILDING `
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LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT G� J-h- MAIL ,_ � -• ��
ADDREInSS,',�///yv�
NO O
SIZE OF LOT NOW ON LOT CITY 1`/ \/ TEL NO
USE OF 1 / DISTRICT NO GROUP CLASS MAP PROCESSED BY
BUILDINGS ) BK p '�'r
� oCONTRACTOR b-13�� .�L �
ADDRESS CONNECTION DATA
C IT<1� y�yl L NO U� aj' A ION L r DEPTH 0
STATE l/��r�`/ LIC MANHOLE REFERENCE
LICENSE NO f� ✓ CLA55 3 c C. j'r LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNE 10 ENGTH PROM
HOUSE SEWER CONNECTING TO YI Y L TO P L L
PUBLIC SEWER @s8.0b'' /
SEPTIC TANK SEEPAGE PIT OR (j/J C NO
PITS AND/OR DRAINFIELD @ sl0 o0 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ s3 00e.!�tzd
CONNECT ADDITIONAL BLDG OR AFFIDAVIT W4IYCN I1SIMINT RECORD INSTR NO DATE O
WORK TO HOUSE SEWER @ $300 (J
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $500 Ix
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING O
SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT 1J
PERMIT NO W
a
INDUSTRIAL In
WASTE APPROVAL Z
OWNER S PERMIT s 2 00 CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS D TE INS P TORS TURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESCRIBED/R_JESIDENTIAL PROPERTY If ABANDON HOUSE SEWER
LSIGNATUREf l
OF PER MTTTEE BACKFILL SEPTIC TANhS ❑
SEEP PIT(S) ❑ CESSPOOLS ❑
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�' ALIDATION JACK R ALLEN
SUPERVISING MECHANICAL ENGINEER
�CK 4M O CASH
V1uC7 ", - `SFR 1,0610D 1CC10- Q