HomeMy Public PortalAbout5520 PARMERTON AVE_Sewer_10/17/1963_Connect additional work to house sewer CESDGS ID--E
76AAPPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
OHN A LAMBIE DODnty Evppl1nneer AGDfleB- ..i �. 0 K 0 �y
WILLIAM A JENSEN SuP 1 0l Bwlda9 7'e P-tp/ e /
LOCALITY
*J y {^
FOR APPLICANT TO FII.L QV
AL
DESCRIPTION LOT NO / OWNER IV
MAIL
/
BLOCK TRACT 3 MAILADDR6/`5 m
SIZE OF LOT ♦ NO W OF N BLDG9
NOOLOT / I C" Te "y 0 EL NO
I G I. I O D
U6Q OF / DISTRICT NO -T'
O MAP PROCESSED BY
BUILDINGS L{J Lam/ / �K PC
CONTRACTOR le T(–
ADDge-- 07F e S 6 CONNECTION DATA
CITY —, �X L NO - ( STATION DEPTH
ATE UPPER r
REGISTRATION NO COUNTY MANHOLE REFERENCE LOWER
d
NO DESCRIPTION WORK_ FEE TYPE OF CONNECTION FROM O
HOUSE SEWER CONNECTING
ECTINO TO Y CURB PL MM L L TO TO P L I,J
PUBLIC SEWER 3E 00 PC NO
SEPTICTANK SEEPAGEPIT OR
PITS ANO/OR DMA INFIELD C 61O 00 CO IMP NO UOp NO O
HOUBE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO _
PRIVATE DISPOSAL SYSTEM 19 00 LLLLLL!!!
CONNECT ADDITIONAL op AFFIDAVIT vIrvp uRH
KrxT RECORD INSTR NO DATE a
WORK TO HOUSE SEWER Y Saw VV
OVERFLOW SEEPAGE PIT GRAINFIELD
EXTN CE59POOL DRYWELL MANHOLE O $B 00
ALTER REPAIR OR ABANDON HOUSE HWY ORST WIDENING
SEWER OR DISPOSAL SYSTEM Y S-00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE ROVA
OWNER'S PERMIT s z o0
AUTHORIZATION TOTAL FEE ` A F1 CONNECTION CHAROE PE
I HAVE AT THIS DATE AGO
WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO C04NECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR 8SIGNATURE
SIGNED THIS DAY OF IB_
OWNER OR - NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK /
ADDRESS
SEPTIC TANK SEEP PIT(-) C
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING _
PLUMBING AND 5EWER5 CESSPOOL ❑ DRYWELL ❑ -
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER ORCE
LIC E0 A8 REQUIRED BY LOB ANGLES COUNTY AND`STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I A THE LEGAL WNER OF AND INTEND TO DISCONNECT PLUG AND
gE91 BE
IN THE ABOVE SCR ED R DQNTIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE L
OF PERMITTEE SEE' PITILL SIS) EC TANKS El
❑ CESSPOOLS
iV,gI.IDATION _ROBERT A WOOD
—M o HASH SUPERVISING MECHANICAL ENGINEER
LACO1 5 6 3G OCT17 1 0 A 5.00" 4