HomeMy Public PortalAbout10536 BOGUE ST_Sewer__ CE808f0-63 APPLICATION FOR PERM
76A641D '-'
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer AD.
WILLIAM A. JENSEN. Sup't of Building
LOCALITY `
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
N / v MAIL a ��
BLOCK TRACT ORJ/ (/I/ ADDRES
NO OF BLDG
SIZE OF LOT NOW ON LOT CITY ' TEL NO.
USE OF DISTRICT NO. GROUP MAP PROCEJ.Y
BU I LD IN
BK PG
co LCA cj
ADDRESS f r� CONNECTION DATA
CITY TEL STATION DEPTH
STATE V 7 UPPER
REGISTRATION OCJ�/at-��®t� ❑ COUNTY MANHOLE REFERENCE `7
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FRO
HOUSE SEWER CONNECTING TO Y. CURB P L. MEL TOP L.
PUBLIC SEWER @ 55.00 e'� IL
SEPTIC TANK,SEEPAGE PIT OR P.G NO. //^
PITS AND�OR DRAINFIELD @ S1000 CO IMP. NO. JOB NO. 6 7�� O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO _ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ S3 00 w
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO. DATE O
WORK TO HOUSE SEWER @ $3 00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD L1J
EXTN,CGESSPOOL.DRYWELL,MANHOLE @ $500
ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST WIDENING h
SEWER OR DISPOSAL SYSTEM @ S3 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S z 00
AUTHORIZATION TOTAL FEE 7 -0 CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIS £CLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGN TURE
SIGNED THIS O 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP,PIT(S)
IHEREBY 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' NO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA AM THE LEGA W_ER OF, NO INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE DESC RI BEW ENT L ROPERTY ABANDON HOUSE SEWER
SIGNATURE 1• BACKFILL SEPTIC TANKS ❑
OF PERMIT PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK M o CASH SUPERVISING MECHANICAL ENGINEER
�. 2 1 4 1 AUG 3 1 o D
7.0 07 a