HomeMy Public PortalAbout5335 ZADELL AVE_Sewer_6/23/1967_CONNECTION TO PUBLIC SEWER 7 3-6.4
76A642D APPLICATION FOR PERMIT
6A64
COUNTY OF LOS ANGELES SEWER—SEWAGE D SPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer A DDRE55� l T
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST /
FOR APPLICANT TO FILL IN CRD55 ST- — --- — -
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�EGAL -
DESCRIP710N .--LOT NO. OWNER
MAIL
BLOCK TRACT ___]_ADDRESS
NO. OF EILOGS.
SIZE OF LOT +',! NOW ON LOT C!TY TEL. NO.
USE OF ! �---
�. DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS - BK PG
CONTRACTOy'-ii.
ADDRES d a y CO ECTTO_N_DATA
STATION ��/ DEPTH
CITY TEL. NO. A
—REGISTRATI --� ATE UPPER
MANHOLE REFERENCE /
_
ON NO. > r COUNTY _ ,41,
NO. DESCRIPTION OF WORK FEE -^-TYPE OF CONNECTION — "LENGTH�F'ROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. -
PUBLIC SEWER @ $5.00 --
SEPTIC TANK SEEPAGE PIT OR —� - J y/ JOB NO.
{-P—ITS AND!OR DRAINFIELD � $10.00 � CO.IMP.NO. L f �� V
r1OU5E 5EWER CONNECTING TO �-
TRUNK PERMIT NO. ROAD PERMIT NO. l
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR T AFFIDAVIT WAIYER EASEMENT RECORD.INSTR.NO.DATE
cx
WORK TO HOUSE SEWER $3.00E
OVERFLOW SEEPAGPIT,DRAINFIELD -- � ___��__
EXTN.,CESSPOOL,DRYWELL.MANHOLE $5.00 LU
• ALTER.REPAIR OR ABANDON HOUSE MWY. OR ST.WIDENING _ _ N
SEWER OR DISPOSAL SYSTEM _- $3.00 STATE ENCROACHMENT
- _.._—_ PERMIT NO.
-- — -- INDUSTRIAL`
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 - --
AUTHORIZATION TOTAL FEE I d CONNECTION CHARGE FEE ----
'I HAVE 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 DATE INSPECTOR'S SIGNATURE
SIGNED THIS_ DAY OF _19_ — --` --_----
OWNER OR NEW HOUSE SEWER -
OWNERS AGENT ---^ --CONNECT
t
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS_ — _ SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WITH ALL COUNTY ORD U--!ANCES AND STATE LAWS REGULATING —
PLUMBING AND SEWERS. CESSPOOL C3 ❑DRYWELL �
I HEREBY CERTIFY THAT I AM PROPER REGISTERED AND/OR ALTER,REPAIR,SEWER OR I
L.I CENSED AS REQUIRED J'-,,LOS AN OUNTY ASND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 4 pbt HE L L ER O AND INTEND TO -- - -
DISCONNECT PLUG AND
RESIDE IN, THE AB CRI ENTROPE RTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ElI
OF PERMITTEE,,: -- - SEEP,PIT(S) ❑ CESSPOOLS ❑
IALIDATION
M.O. CASH ROBERT A. WOOD
d SUPERVISING MECHANICAL ENGINEER
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