HomeMy Public PortalAbout6424 BARELA AVE_Sewer__ •i 4G 3„It-aa APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY S EW E R--SEWAG E DISPOSAL
D"aftmKd of Co—tt Enabwft
Cowft of Las Angg" BUILDING etc e�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRLSS.
m - t;`ABHATT D. GRIFFIN, SUPT OF MUILDINO LOCALrrT
FOR APPLICANT TO FELL IN
NEAREST ST. - V
LEGAL
DESCRIPTION LOT NO. OWNER X
MAIL
BLOCK TRACT' o, kito 7 ADDRESS
N0.
SIZE OF T XOW OlrON BLDLOTeS. CITY TEL N0.
U1 OFDING6
I - DISTRICT NO. GROUP YAP
UI
BK PG
CONTRACTOR
COMEGTION DATA
ADDRESS
CITY XO STATION DEPTH f
MANHOLE REFERENCE _ UPPER
❑ STATE
REGISTRATION N0. ❑ COUNTY
No. DESCRIPTION OF WORK FEE
TTPE OF CONBECTIO 1 Y
'LENGTH FYO "/o
HOUSE SEWER CONNECTING TO Y. CURB Y.L..L.TO P.L. C�
PUBLIC SEWER 3.30
SEPTIC TANK,SEEPAGE PIT OR -
PITS AIID/OR DRAIXFIELD0 s 3.00
OVERFLOW SEEPAGE PIT,DRAINFIELDP_C. Np.
EJMX.,CESEPOOL DRYWELL MANHOLE S 2.00 CO. IMP. 0. JOB NO.
HOUSE SHWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM #1.00 TRUNK PERMIT NO. - RbAD PERMIT No.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 41.00 PERMIT NO.
ALfbi,REPAIR OR ABANDON HOUSE '
INDUSTRIAL
EWER OR DISPOSAL SYSTEM 40 11.0-0 WASTE APPROVAL
CHARGES
- COXNECTIOX CHARGE FES _
OWNER'S FEHMIT f 1 00 �,n Q-
AUTHORIZATION Tp'iAL FEE REIYBUR9EYElfT FEE /�L
.I HAVE AT THIS DATE A CONTRACT WITH THE HEREINn:AND CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED E7(ISTING pWELL)NG
TO THE PUBLIC SEWER. NEW HOUSE SEWER g-�L• �, ,/�
SIGNED THIS SAY OF �'^19�7 CONNECT ADDITIONAL
OWNER 'OR ' BUILDING OR WORK
-
OWNERS AGEKT SEPTIC TANK,SEEP,PIT(&)
ADDR AND/OR DRAINFIGLD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ADOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTU,REPAIR,SEWESj OR
PLUMBING AND SEWERS. SEWAGE Dl>IPOSAL' YSTHId
I HEREBY CERTIFY THAT 1 AM' PROPERLY P9019MED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND $TATE OF ABAN N HO EEfEWER
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN PROPERTY. BACKFILL SF1TIC TA71�6❑ /
SIGNATURE SEEP.PIT(! ❑ CEi3FbOLE /
OF PERMITTEE
JOHN A- LA I COUNTY ENGINQHR VALIDATION ROBERT A.WOOD, CHIEF PLEIG. INSPECTOR
■.0.
1 .1 4 X12 450 11