HomeMy Public PortalAbout5827ALESSANDRO AVE_Sewer 76A64 10.82 A lae CATION F �ERMOT �I
78A842D 6`99-" CATION 1� I�uvn
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 1BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS �fy
WILLIAM A. JENSEN, Sup't of Building 6j
LOCALITY
NEAREST C
FOR APPLICANT TO FILL IN CROSS ST. 0 7z a 044
LEGAL
DESCRIPTION LOT NO. fp* OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF SLOGS.
SIZE OF LOT jNIDW ON LOT CITY - TEL. NO.
USE OFJ� DISTRICT NO. GAROUy MAP PROCESS BY
BUILDINGS -/(/- //)�
CONTRACTOR d 1
ADDRESS &64-j'lo
- /y J CONNECTION DATA I
CITY f j TEL/NO. S< STATION /'/aft '•DEPTH
STATE MANHOLE REFER✓ENCE
REGISTRATION NO. COUNTY a1 LOWER �„
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR#M O
HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. V
PUBLIC SEWER @ $5.00
P.C.NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. A� O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. /{
PRIVATE DISPOSAL SYSTEM @ $3.00 C,9
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR.NO. DATE a
WORK TO HOUSE SEWER @ $3.00 h
OVERFLOW SEEPAGE PIT.DRAINFIELD z
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 2 00
- CONNECTION CHARGE FEE CHARGES
AUTHORIZATION TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIAL,
APPRO tl�yALS DATE I NSPECTOR'S SIGNATURESIGNED THIDA OF /OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDINGOR WORK
ADDRESS7.0
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IE)
CERTIFY T 1 AM P PERL REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REOUI BY LOS G ES OUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH I AM THE GAL O ER OF, AND INTE TO DISCONNECT PLUG AND
RESIDE IN, THE DESCRIB D R IDE TIAL PERT Y ABANDON HOUSE SEWER
SIGNATUR - BACKFILL SEPTIC TANKS ❑
OF PER F1SEEP,PIT(S) [I CESSPOOLS
L ATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
M.O. CASH
LAW 5 4 9 4 NOV 2 1 0 D 7.0 0
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