HomeMy Public PortalAbout6414 BARELA AVE_Sewer__ 7 "6411D
46APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-S EWAG E D 1 S POSA L
D.perbs.m.f of ton EnQt—
CC1mty of 1'OS ~ BUILDING
I FYI
WM.J. FOX, COUNTY ENaIN¢¢R
CAIIATT D. GRIFFIN, Sur-T of nulLr)Lmo LOCALrTY
IJFOR APPLICANT TO FILL IN NEAREST
CROSS ST,
LEGAL
DESCRIPTION LOT NO.
BLOCK TRACT MAPL
ADDR"SV4,14N
N0. OF BLD
SIZE OF LOT 5VX //0 NOW ON LOT CITY TEI•- NO.
USE OF
BUILDINGS D19TRICT NO. GROUP YAP
CONTRACTOR G[ rG
I 1�
ADDRESS CONNEMON DATA
CITY J&2 L. NO. -- STATION 3 DEPTH
_ ❑ STATS - U"H0LEE RE FEE EN CFE
REGISTRATION N0. a S ❑ COUNTY LOW XR
TYPE OF CONXRCTI LENGTH FROdr
N Of DESCRIPTION OF WORK FEE Y URB. M. TO P.L.
HOUSE SEWER CONNECTING TO
RUBLIC-SEWER 0 9.50
HOUSE SEWER CONNECTING TO
rRIVATE DISPOSAL SYSTEM 1.00
CONNECTADDITIONAL BLDG. OR CO. IMP.N0. � I JOB. N0.
MOR[TO HO SE SEWER 1.00 _ D Ji
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO, ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMID(T
AND/OR DISPOSAL SYSTEM 1.00 MIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AMD/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL NAM APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARG
i
CONNECTION CHARGE FEE
OV NE YS PEMIZUT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURBEYEIIT FEE
1 HAVE THIS DATE CONTRACTED WITH E HERRIN RAYED CON-
TRACTOR TO��0 MNECT THE ABOVE D"C ED I DWELLING AMOYALS DA IXSPEC40R S SIGXATU
TO THE PUB,IIIC !EWER ''C/
SIGNED THI AY OF 19.L5.Z NEV HOUSE SEWER
OWNER OR OONNECT ADDITIONAL
OWNERS AGEIIT BUILDING OR WORK
SEPTIC TANK,SEEP PIT(S)
ADDREE AND/OR DRAINFIELb
1 HEREBY ACKNOWLEDGE THAT CtS$K OL❑ DRYwxLL❑
AMD STATE THAT THEABOVE LS CORRECT D AGREE TO tON
LYWITH ALL COUNTY ORDINANCE! AND iT I.AMD REGU NG ALTER,RETAIN SMER OR
PLUMBING AND SERFA7. SEYAG[DLI, AL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLT REGISTERED AND/OR DIBCONNICT PLOD AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AY THE LEGAL OWIIER OF THE ABOVE ABANDON HOUSE[EWER
DESCRIBED RIl1D[NTIA OP®TY. DACE]'ILL C TAIfI(E
eO_
[Er rrr s
SIGNATURE
OF PERMIT
SMI I t mu J.F uw"Zmatip IIot VALM47M
LIY AC0;Y5 2 7!R se 6 ^4 450 '
DUUTT / 1 (� DEPUTY
BY
DEPIITT r DI?PUTT
l