HomeMy Public PortalAbout6354 BARELA AVE_Sewer__ APPLICATION FOR PERMIT ,
eeDIVISION OF BUILDING AND SAFETY- SEWER-SEWAGE DISPOSAL
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JOHN A. LAMB{E, COUNTY ENGINEER ADDRESS
m CASSATT D, GiRIFIrIN, HUN'TOrSUILDING LOCALITY
FOR APPLICANT TO FILL IN CROF''p"ST.
LEGAL -
DESCRIPTION LOT NO. OWNER
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BLOCK Tit ACMAIL
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SIZE OF LOT I,D XOW ONB OTS CITY 7 C TEL No.
USE OF
UILDINGS I DISTRICT NO. 'GROUP MAP
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CONTRACTOR .,
ADDRESS .2 Z �iO ON D?LTA
ATION DEPTH
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STATE { TOWER
RSGIMAT10N NO. ,S COUNTY
No. V�SCRIPTION OF WORK FEE
HOUSE SEWER CO"ECTING TO 7TPE OF CONNECTI LENGTH FROM
PUBLIC SEW a 3.L0
Y. CURB P.L. Y.L.TO P.L.
SEPTIC TANK,SEEPAGE(PIT OR
PITS ASID/OR DRAINFIELD ® $3.00
OVERFLOW 3EfEPAQE PIT,DRA NFIE CO. LY P. No. JOB WO.
EXTN.,"C POOLF— Y�NHOLE 2.00
HOUSE 11 7ER CONNECTING TO ,
PRIy TE DISPOSAL STEM 1.00 TRUNK P@IMI NO. 'ROAD PERMIT NO_
CONNECT AD ITIONAL BLDG.OBSTATE ENCROACHMENT "
W BK TO HOUSE SEWER @ 1.00 PERT N
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 1.00 WATT APPROVAL
CHARGES
CONNECTION CHARGE FEE '
OWNE]E'S PEUCT S t 00
AOTHORIZA�ION MTAL FSB v AEIYBURSEMENT FEE_
I HAVE AT THIS DATE A CONTRACT WITH EIN NA
THE HEREIN CON- APPROVALS DATB INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE "OVE DEMCRIBED EXISTING DWELLING _ 1
TO THE PUBLIC SEW ��..j,// NEW HOUSE SEWER S _
SIGNED THISE AY OF 19.3L CONNECT ADDITIONAL
OWNER ORBI)ILDING OR WORK _
OWNERS A.GeNT2!�" SEPTIC'TANL LEEP,PIT(0)
AD RM AN /OR DRAINFIELD
IH
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CEBBPOOL❑ DRYWELL❑
AND STATE( THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ER,REPAIR,SEVER OR
LT
PLUMBING AND SEWERS. AGE DISPOSAL STAT—EM
I HEREBY CERTLFY 'THAT I AY PROPERLY RHGISTERED AHD/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE 0p DR"DONHOUSESEWEISCO"ECT PLUG p
CALIFORNIA OR THAT 1 AN THE LEGAL QWNER OF THE ABOYg DON HOUSE BHWEZi
DESCRIBED RESIDENTIAL P OPERTY. RACXFILL SEPTIC TANKD
919MATURE ./r SEEP.PIT($) [I CESSPOOLS
OF PERJUTTEE Z(/ 1.1
JOHN A. LAMSIE, COUNTY ENGINEER VALIVATIO R08ERT A.WOOD. CHI¢F PLEIG.{NGPECTOR
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