HomeMy Public PortalAbout10533 BOGUE ST_Sewer__ 1
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7C E80,8 6AC�42D APPLICATION OR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS �� 3
WILLIAM A. JENSEN. Sup't of Building
LOCA LiTY
NEAREST
00,
FOR APPLICANT jp-FILL IN
LEGAL
DESCRIPTION LOT NO OWNER
M
BLOCK TRACT
NO OF BLDGS -
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GROUP MAP PG PROCESSED BY
BUILDIN
BK
CONTRACTOR O�
ADDRESS y CONNECTION DATA
STATION �� DEPTH
CITY L. 7,
ATE MANHOLE REFERENCE UPPER
REGISTRATION NO ❑ COUNTY Sys
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION` LENGTH FROM
HOUSE SEWER CONNECTING TO ^ ,., Y CURBP L M L TO P L
PUBLIC SEWER @ $5.00
93-
SEPTIC TANK,SEEPAGE PIT OR JP.0 NO. _ O
PITS AND/OR DRAINFIELD @ SIO 00 CO IMP NO OB NO � V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300 ^
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMEMT RECORD INSTR NO DATE H
WORK TO HOUSE SEWER @ $3 00 ()
OVERFLOW SEEPAGE PIT,DRAINFIELD LU
EXTN,C E SSPOOL,DRYWELL.MANHOLE @ $5 00 d
ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h
SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT Z
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 Oo
AUTHORIZATION I TOTAL FEE - h� CONNECTION CHARGE FEE
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING'DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SI r ATURE
SIGNED THISOF 19_ ?-44
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH AM THE LEGAL OWNER OF, AN INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE O DESCRIBED R ENTIAL PRO RTY. ABANDON HOUSE SEWER
SIG AT R E BACKFILL SEPTIC TANKS El
OF PITS) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK. M O CASH
SUPERVISING MECHANICAL ENGINEER
L&2 1. 3 7% AUG 3 1 0 D 7.0 0"