HomeMy Public PortalAbout10542 BOGUE ST_Sewer__ ,0-69
76A642D APPLICATION FOR PERM T
6A64
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O o�
JOHN A. LAMBIE, County Engineer ADD.ESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN DRABS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT 61
ADDR
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY ( G. TEL. NO.
USE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS
BK PG
CONTRACTOR L7 i
ADDRESS CONNECTION DATA
CITY �f TEL ® STATION-/ DEPTH
S ATE UPPER
MANHOLE REFERENCE '3,3 T�
REGISTRATION NO. ❑ COU NTV G LOWER
NO. DESCRIPTION F WORK F E TYPE OF CONNECTION LENGTH F M
HOUSE SEWER CONNECTING TO ®� Y. CURB P.L M.L.TO P.L.
PUBLIC SEWER @ 55.00
CL
SEPTIC TANK,SEEPAGE PIT OR P.C.NO. /. ^O O
CO.IMP. NO. JOB NO. V/J /G'
PITS AND/OR DRAINFIELD @ $10.00 V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00 /�
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENI RECORD, INSTR.NO. DATE 0
WORK TO HOUSE SEWER @ S3.00 (�
OVERFLOW SEEPAGE PIT,DRAINFIELD L!J
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ S5.00 C'
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING N
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 2 00 CHARGES
AUTHORIZATION I TOTAL FEE O 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 SIGNATURE
SIGNED THIS DAY OF 19_ I
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND TATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OW. R OF, AN IN END TO DISCONNECT PLUG AND
RESIDE IN, THE DESCRIBED RES TIAL P ERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ElOF PERMIT SEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
2 1 4 2 AUG 3 1 0 0 7.0 0