HomeMy Public PortalAbout5946ALESSANDRO AVE_Sewer a
ES08
D It APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING (c/
MB
JOHN A LAIE County En eer ADDRESS / T y
CASSATT D GRIFFIN Sup t of Building LOCALITY
FOR APPLICANT TO FILL IN CROSS sr - - -.•vr� `
LEGAL . / - _
DESCRIPTION LOT NO IL (— + ) OWNER et�L
BLOCK TRACT MAIL
ADDRESS
NO OFIBLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP
CONTRACTOR BK PG
ADDRESS CONNECTION DATA
CITY TEL NO !� STATION 211, DEPTH
/ STATE MANHOLE REFERENCE l
REGISTRATION NOY COUNTY / OWER
NO DESCRIPTION OF WORK
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3
SEPTIC TANK SEEPAGE PIT OR TYPE OFC ON LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y URB 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 ,
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO 3 3
ALTER REPAIR OR ABANDON HOUSE e
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION `TOTAL FEE 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 DAYY F 7� g NEW HOUSE SEWER
OWNER OR h��_.�L/� CONNECT ADDITIONAL - - --
OWNERS A T BUILDING OR WORK
ADDRESS — SEPTIC TANK SEEP PIT(S)-
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAf I HAVE READ THIS APPLICATION .�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _CESSPOOL❑ DRYWELL F=l — ^�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
I HEREBY CERTIFY—THAT I AM PROPERLY REGISTERED AND/011— SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES GOUN Y AND STATE OF DISCONNECT PLUG AND
CALIFORNI R THAT 1 AM THE GAL 0 N R OF TH ABO ABANDON HOUSE SEWER
DESCRIB ESIDE IAL PROPERTI�r BACKFILL SEPTIC TANKS❑V
SIGNT E EEP PITS) ❑CESSPOOLS
OF PE
VALiDATI� �� ROBERT A WOOD =�^�
cK u o CASK SUPERVISING MECHANICAL ENGINEER
UjC0 2-1 6 3 cu'-'% FEB 310- A -- -- 500