HomeMy Public PortalAbout6409 BARELA AVE_Sewer__ 1'76AG41D7�3 APPL.I•CATION -FOR PERMIT � 7
.18 iA 9.15"IR-54 ■
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL i
DfpmrWm f of Gmmt! Eaginew
County of Los AnQal�s BU 1 LD I
' WM.J. FOX, COUNTY ENGINK q 'VDDR
Ck§*ATT D. GRIFFIN,fvr•T or NUMMima LOCALm
FOR APPlICANT TO FILL IN NEAREST
CRO-83
LEGAL
'DESCRIPTION LOT NO. GYNE[
BLOCK TRACT MAIt
NO.OF BLDG1. ADD
SIZE OF LOT NOW ON TTEL
USE OF
BUILDTNG6 r DI1lR1 Q. G OUT' I YAP
CONTRACT R
7 -- SKFG
ADbR C0NXB=0N IJATA
CI TE STATION DEPTH
I ^ ❑ STATE } MANHOLE RfrFGRENCE
REGIITRATION NO. - l(Y� �/ ❑ COUNTY LORfE
TYPE OF CONNECTION LENOTH FROM
No. DESCRIPTION OF-WORK FEE T. CURS P r. ro .L..
HOUSE SEWER COX ECTI G TO
_ PUBLIC SEWER Q $ 3.50-
HOUSE 3EW�R ONN�ECC''1 Q TO
.PRIVATE DISPOSAL BYf"fE 1.00
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER 1.00 CO. IMP.N0. JOB. NO.
'ALTER OR REPAIR EX STING
SEW OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
D1EECgqN(ECT AND A13ANDON SEWER ➢TATE ENCROACHMENT
ANDfbR P15POSAL SYSTEM 1.00 PERMIT NO.
PT1C TANK,SEEPAGE P T OR
ITS AND/OR DRAINFIELb 2.00 INDUSTRIAL
CESSPOOL-DR ELL 'WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 rHARGES
CONNECTION CHAAGE FEE
1� QWNE'S �T ,s 1 Op
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE 7H13 DATE CONTRACTED WITH THEHEERREIN NAMED CON- $Ovs"1J..� DATE IN PECTbR' SIGNATURE
TRACTOR TO CORNECT THE ABOVE DESCRIBED E]IrlMG DWELL IN4
TO-THE PUBLIC 3
�✓� NEW HOUSE SEWER
SIGNED THI DAY 0 Ig��
OWNER R CONNECT ADDITIONA-L
OWNERS t• BUILDING OR WORK
Uj(• SEPTIC TANK,EEEffpp,� PIT($)
ADD AND/OR DRAINFIELD
I H¢¢iiEBY LEDG[ THAT i HAVE READ PHIS APPLICATION CESSPOOL❑ DRYWKLL❑
AHD dTATE AT HI ABOVE 13 CORRECT AND A-QRE[ TO COMPLY.
WITH ALL 0 ORDINANCES AND STATE LAWS REGULATING
OR
pLUYBIN A SEWER.S. ALTER, DIVPO,SEVER EM
SEWAGE Dl➢P09AL SYSTEM
I HEACERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
L1CIiNSED AS REQUIRED BY LOS ANGELK41 COUNTY QUID: 6TATY OF DISCONNECT PL"A}}��D
CALIFORNIA OR THAT. 1 AY THE GAL OWNER OF THI ABOVE ABANDON HOUSE EEM1Qt
DESCRIBED ROIDKNTLAL P TY. BACJ[FILL C TANKS❑
- 1H�P PR f CY6fPW-[,f
SIGNATURE
OF PERMI
WIL-Lkm J.FOX. COUNTY ENMINIKIElt VMMATION
'*
'&7 3 .3 ]fes AN 31 4 5.5 0 �
DKPUTT DEPUTY
' RY 4T
.:m DEPUTT DfPUTT ��