HomeMy Public PortalAbout5320 BARELA AVE_Sewer__ ;eA -66
E•888 11.88 APPLICATION FOR PERMIT 1
8& '
DIVISION-OF BUILDING AND SAFETY SEWER-S EWAG E' D I S POSH L
Department of County.Engineer
County of Los Angeles BUILDING.
JOHN A.'LAMBIE.COUNTY ENGINEER ADDRESS
® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSSS T
LEGAL OWNER
DESCRIPTION LOT N0.
AIL
BLOCK TRACT SADDRESS
SIZE OF LOT
NO.OF SLUGS. CITY TEL. N0. ,3
NOW ON LOT
USE DISTRICT NO. GROUP -MAP
BUILDDINGS
: BK - PG.
CONTRACTOR
- Z> !
ADDRESS 717 be /A'& r CO ON DATA
STATION DEPTH
CITY TEL.NO'. MANHOLE REFERE E - UPPER
STATE LOWER
REGISTRATION NO.. . 0 ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CON ON PGTFRO ,
PUBLIC SEWER C $3.50 Y.: CURB P.L. L.-TO P.1.
SEPTIC TANK,SEEPAGE PIT OR
PITS-AND/OR DRAINFIELD @ $3:00
OVERFLOW SEEPAGE PIT,DRAIRFIELD P. C.'NO. —
EXTN.,CESSPOOL,DRYWELL,.MANHOLE® $2.00' CO.1MP..NO, JOB NO.
i HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM @ $•1.00 TRUNK PERMIT NO. R D PERMIT N.Q.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACH NT
WORK TO HOUSE SEWER .. ® $1.00 PERMIT HO.
ALTER,REPAIR.OR ABANDON HOUSE INDUSTRIAL
SEWER.OR DISPOSAL SYSTEM (a $.1.00 WASTE APPR AL
CHARGES
CONNECTION CHARGE FEE
OWNWS PERMIT 3.4 00 REIMBURSEMENT FEE '
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED .COW APPROVALS- DATE' INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF ]9 60KNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(SI
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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 AM PROPERLY REGISTERED AND/OR` DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF pgpNDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER-OF THE ABOVE
DESCRIBED RESIDENT L PROPEYN. BACKFILLSEPTICTANKS❑_
SIGNATURE Lou SEEP'.PIT(S)❑ CESS LS
❑ i
OF PERMITTEE 'rV
JOHN A.LAMBIE.COUNTY ENGINEER f ATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
• CK. M.O. CASH
L&5 8 0 0,co' OCT'15 110 A 3.00 ,A