HomeMy Public PortalAbout5227 BARELA AVE_Sewer__ $&E8 s,?:S4` APPLICATION , FOR PERMIT
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSH L
Department of County Engineer
County of Los Angeles BUILDING c:•_2_ -2-.--7
WM.J. FOX. COUNTY ENGINEER ADDRESS ''1
CASSATT D.GRIFFIN,SUPT OR BUILDING LOCALITY ��F Hr� (D L_� � (T
FOR APFLICANT�yTO FILL IN NEAREST. I•- ► C i DESLEGAL
CRIPTION LOT NO. 6� !/+ OWNER nelart lJ IIN �j'�Q
BLOCK TRACT1"'� p ADDRESS Z Z I yi a T L P^-'
SIZE OF LOT / NOW ON LOTS' CITY Z D _r_)f`r.
TEL.NO.
USE OF �
BUILDINGS (E l.a_ I F-I �r� C�°t% t,w�-. DISTRICT N0: GROUP MAP
HK PG
CONTRACTOR
ADDRESS t ((/ a' CONNECTION DATA `
CITY TEL.NO. 7 �fJ Q STATION IE-)e1�4'!NCf- LQN"RffTa '-t
STATE MANHOLE REFERENCE
REGISTRATION NO. - '
COUNTY UPPER LOWED OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.L.' M.L.TO P.L.:
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER ® $ 8.50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR pj CO. IMP.NO. JOB. NO.
WORK TO HOUSE SEWER 1.00
ALTER-OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 'TRUNK PERMIT N.Q. ROAD PERMIT NO.,
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ .AND/OR DISPOSAL SYSTEM 1:00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRY-WELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 3 1 00'
AUTHORIZATION TOTAL FEE' d� REIMBURSEMENT FEE
I HAVE
TRACTORTTO CONNECT THEHIS DATE AABOVECTED WDESCR BED EXISTINGITH THE HEREIN ADWELLIING' APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19- NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR.`
OWNERS AGENBUILDING OR WORK r i�r3
T ' -
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[JDRYWELL❑
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
1 HEREBY CERTIFY THAT 1 ADA PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY. LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 13SEEP:PITS) ❑ CESSPOOLS❑
i
SI'GN'ATURE
OF-PERM ITTEE-
WILLIAM J.FOX.COUNTY ENGINEER - VALIDATION
HYHALO jY 6 9 212 SEP 4
DEPUTY DEPOT
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BY BY
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DEPUTY '
DEPUTY
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