HomeMy Public PortalAbout6408 BARELA AVE_Sewer__ ./i 406311-5.
711.84
P TION . FOR PERMIT
DIVISION OF B G AND SEWER-SEWAGE DISPOSAL
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} WU.J. FOX, COUNTY ENa1NfEi S
CA MRATT D.ORIP71N, Sup-T or■uumma LOGALM
FOR APPLICANT TO FILL. LN CA048 r
O/S Si.
LEGAL.
DESCRHInON LOT NO. OWNER .
BLOCK TRACT _ 14 G PAIL
Q ADDRESS
S
SIZE OF LOT 7k � HS/OOX LOT /-r CITYTEL NO.
USE OF
BUILDINGS P& DISTGICT No. GROUP I MAP
BE P9
CONTRACTOR
ADDRESS CONDIGN DATA
CITY STATION 6 DEPTH
❑ STATE 1 PRINCE
REGISTRATION NO. ❑ COUNTY63UPP stat
TYPE OF CONNE LENGTH FROM
NO. DESCRIPTION OF WORK F" T CURB P.L. Y.L.TO P.L.
HOUSE SEWER CONNECTING TO ■
PUBLIC SEWER 7.60 01c _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP.N0. JOB. N0.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCNNECT AND ABANDON SEWER STATE ENCROACHMENT
AND
FOR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TI�NK, SEEPAGE PIT OR
PITS AND/OR DRAIXFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLT 2.00 I CHARGES
CONNECTION CHARGE FEE
OWLS PERbUT $ 1 00
AU-TEOEIZATION TOTAL Fly REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONN-
TRACTOR TO CONNECT THE ABOVE DESCRIBED DWELLIP19 APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S
SIGNED THIS AY OF NEW HOUSE SEWER
OWNER TOR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC-TANK,SEEP, PIT(S}
ADDRES i id flKND/OR DRAINFIUD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DCYWM-L❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AHD STATE LAWS REGULATING A,TER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HERIBT CERTIFY THAT I AN PROPERLY REGISTERED AND/OR
LICENS D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OHNE'[ OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED R[SIDENTLAL FROPimTY. BACKFILL S C TAR KS 11r SEEP CT ,M,POOLS
SIGNATURE
OF PERMITTEE
WILLS"J. FOX,CowmrY KKQImm VALLDATLON
By .NogTS 4 5S AIG18 4 4.5 Or
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