HomeMy Public PortalAbout6353 BARELA AVE_Sewer__ ;`" 711.,, APPLICATION FOR PPERMIT 1
Dri=ON OF BUILDING AND SAFETY SEWER—SEWAGE D I S PO SA L
D.pcatmant of Com EaQ�..[
County of Lol Aly-A .UILDINO
WLL J. FOX, COUNTY EMIGINXZ7 ADDRESS
r SSArr D. GRIFFIN. Ot1P'T of■ummmcs LOCALITY
FOR APPLICANT TO FILL IN nEw" 1
LEGAL
DESCRIPTION LOT NO. OWRER '
BLOCK
TRACT Z 7 AD DRESS J
NO.OF BLDG&
SIZE OF LOT I NOW N LOT CITY MEL.N0.
USE OF
BUILDINGS DISTRICT NO. OROl1P MAP
a Pa
CONTRA oa ,5'"•
ADDRESS CORZIE=01i DATA
CITY L4
TEL. XO. 9TAT101 7 DEPTH J'
❑ STATE MANHOLR RRFCRENCR
REGISTRATION NO. D ❑ COURTT I LOWER
TYPE OF CONNECTIONLENGTH POM C
No. DESCRIPTION OF WORK FEE 1- M.L.To L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 3.50 S
HOUSE SLrWEjR CONNECTI G TO
PRIVATE DISPOSAL SYSTE 1.00 N
CONNECT ADDITIONAL BLDG. ORCp, 1yP. N0. J V JOB. NO.
WORK TO HOUSE SEWER 1.0.0 _ffsL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
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- DRYWELL WASTE APPROVAL
SPECLAL CONDITIONS ONLY 2.00 CHARGES
CON-NECTION CHARGE FLE
�i
O7wy Ia'$ PE1WY S 1 00
AUYHORT�ATION TOTAL FEE yr REIMBURSEMENT FEEn r
11 HAVE THIS DATE CONTRACTED WITH THE HEREIN MAXED CON- AP�ROVAI� DAT INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCR-IBED D(ISTIl19 D�LL1116
TO THE PUBLIC f NEW HOUSE SEWER
THIS ! Y OF 10
OWNER OR CONNECT ADDITIONAL .
OWNERS AGENT BUILDING OR WORK
ADDRESSSEPTIC TANK,SEEP PIT(f)
AND/OR DRAIN?qKLb
I H¢IEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSFOOL❑ DRYYELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDIXAXC[f AND /TATE LAWS REGULATING ALTER,REPAIR,SEWER OR
P,LUMBI��XG ARb SEWERS. SEWAGE DISPOSAL SYSTIN
LICENSEde CR�EpU RETIFY QUIRED BY LOS ANpOPERLY�IREGIs A D/OOP DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 A��1I THE LEGAL own OF THE ASOVR ABANDON HOUSE SEWER
DrSCRIB® RRSID[XTIA PR9PElTy. eAC!<E' S C TANKS r /
J
.SIGRATURE Z1.
OF PERM
wt, , "J, F Nclouwry t1rNoLmmn YALIDATM
ST -ACOS �0 2n SEP19 4 5.50 . >n
DEPUTY DEPUTY
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m DEPUTY DEPUTY