HomeMy Public PortalAbout5606ALESSANDRO AVE_Sewer (2) D
5 E-663 11.55
_ APPLICATION FOR PERMIT 1
S&E-6
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles AD RESSGL Q
JOHN A. LAMBIE, COUNTY ENGINEER -
® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEG
DESC TIONQ_.�OT N0. OWNER
t . MAIL �S�
BLO TRACT DRESS
N0.OF BLDGS. CIT TEL. N0. D
S L NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
I o&---, PG
CONTRACTOR
ADDRESS rijL10, CONNECTION DATA
CITY t d TEL. NO. ST TON "T p�i Q DEPTH _
I C I f J MANHOLE REFERENCE UPPER rt
_ STATE LOWER 1!
REGISTRATION NO. �'� �� _COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
_PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. N0. JOB N00
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 _ S
HOUSE SEWER CONNECTING TO J/ �-
__ PRIVATE DISPOSAL SYSTEM @ $1.00 _TRUNK PERMIT NO. ROAD PERMIT NO. /0 / D
CONNECT ADDITIONAL BLDG.OR __ STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 - _ _PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
S R OR DISP ASYSTEM @ $1.00 WASTE APPROVAL
CHARGES 14
_— CONNECTION CHARGE FEE �
OWNER'S PERMIT $
AUTHORIZATION TOTAL FEE 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. NEW HOUSE SEWER
SIGNED THOS OF�J19 CONNECT ADDITIONAL
OWNER A 1��G�R BUILDING WORK
OWNERS AG NT WI SEPTIC TANK,
SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
WER
CALIFORNIA OR THATI M THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA OPERTY. /5 BACKFILL SEPTIC TANKS❑
SIGNATURE
SEP.PIT(S) ❑ C SSPOOLS E)� / f
OF PERMITTEE ./ _ 'J}
JOHN A. LAMBIE. C9rUNTY ENGINEER .,� ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
(`SCK'. 0. CASH
L 0 6 3 0 SEP 2 5 5 25-00 to