HomeMy Public PortalAbout5327 BARELA AVE_Sewer__ CEBDB 3-62 APPLICATION FOR PERMIT.
7BA642D
-COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT.OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS.
W"MM A. JENSEN. Supt .of,Building „
LOCALITY
NEAREST
FOR .APPLICANT TO FILL IN CROSS ST, haA
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK •TRACT /a ADDRESS
NO, OF SLOGS.
SIZE OF LOT NOW ON. LOT •CIT T_EL. :NO.
USE .OF
BUILDINGS DISTRICT NO tt
MAP 17=
/SPG
CONTRALTO _/
ADDRESS CONNECTION ATA
CI:T T.L. NO.
� STATION DEPTH
STATE. MANHOLE'REFERENCE LOWER
- PPER
REGISTRATION NO. It ❑ COUNTY
..NO. IDES GRIP O O WOR FEE. TYP. F NECTiO LENGTH FROM
HOUSE SEWER CONNECTING TO Y. P. M.L.TO-..L. _
PUBLICSEWER. '! $5:00o
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0' $10_.00 CO.IMP.NO. O• V
'HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD
CONNECT
PRIVATE:DISPOSAL SYSTEM $5,00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT -WAIVER EASEMENT RECORD...INNO.STR, DATE
WORK TO HOUSE SEWER a $9.00
OVERFLOW SEEPAGE PIT,DRAINFIELD _
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $5.00
ALTER.REPAIR OR ABANDON HOUSE' HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM 0 $8.00 STATE ENCROACHMENT
PERMIT NO. _
- INDUSTRIAL
WASTE APPROVAL _
OWNER'SI PERMCHARGESIT oo - - '
CONNECTI ARGE FEE
AUTHORIZATION TOTAL FEE.
-I HAVE AT THIS DATE A CONTRACT WITH THS HEREIN NAMED CON REIMBURSEMENT.FEE'
_TRACTOR TO CONNECT THE ABOVE, DES CD,RIBEEXISTING DWELLING
TO THE. PUBLIC SEW". APPROVALS DATE .INSPECTOR'S:SIGNATURE
SIGNED THIS MY 6F 1.8_
OWNER OR' NEW'HOUSE SEWER
OWNERS AGENT - _
CONNECT ADDITIONAL ♦ .•�
ADDRESS BUILDING OR WORK �� ��' ,,.-7•,,✓,t•
I F
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ' THIS :APPLICA'T'ION SEPTIC TANK.SEEP,PIT•(S) 6
ANO/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. - CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORALTER;REPAIR;.SEWER OR
LICENSED AS REQUIRED.;BY LOS ANGLES. COUNTY AND STATE OF SEWAGE.:DISPOSAL SYSTEM
CALIFORNIA OR THAT i AM THE LEAL O OF, AND INTEND TO DISCONNECT pLI1G AND _
RESIDE IN. THE OVE DESCRIBE RES AL• PROPERTY. ABANDON HOUSE;SEAND
WER
SIGNATURE - BACKFILL SEPTIC TANKS, ❑ -
.OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ -
3CVALIDATION ROBERT A, W0015
M.O. ' CASH
SUPERVISING. MECHANICAL ENGINEER
t 0 9 0 W2 OCT 1 1 0 D 5.0 0- v