HomeMy Public PortalAbout10554 BOGUE ST_Sewer__ E808-s,6-63
76A6426A642D APPLICATION FOR PER IT
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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 J J ji
WILLIAM A. JENSEN, Sup't of Building �!
LOCALiTV C� �
NEAREST
FOR APPLICANT TO FILL IN CROSS 5T
LEGAL
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT O ADD ES
NO OF BLDGS r
SIZE OF LOT NOW ON LOT CITY ``�. TEL. NO.
USE OF
BUILDINGS 1 DISTRICT NO GROUP MAP PROCESSED BY
BK
PG
CONTRACTOR V i O,? ,7 �I fir✓ �'
ADDRESS3 7,Ce4 z5777: /^) CONNECTION DATA
CITY STATION ,1/�f DEPTH
STATE `C! UPPE
REGISTRATION NO ❑ COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROPW
HOUSE SEWER CONNECTING TO M Y CURB P.L. M L TO P L. __215
PUBLIC SEWER $5 00 V v
IL
SEPTIC TANK,SEEPAGE PIT OR PC.NO. / ^ O
CO IMP NO JOB NO 1V1
PITS ANO/OR DRAINFIELD @ 31000 C�/17� V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300 ^
CONNECT ADDITIONAL BLDG OR AFFIDAVIT wA1YEa [�5[AI¢Ni RECORD INSTR NO DATE 0
WORK TO HOUSE SEWER @ $300 (�
OVERFLOW SEEPAGE PIT,DRAINFIELD I7.!
EXTN,CESSPOOL.DRYWELL,MANHOLE @ $5 00 CL
ALTER.REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N
SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ z 00
AUTHORIZATION TOTAL FEE 0 CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TOCONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS—DAY, OF 19_
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 15 CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSEDAS REQUIRE LOS ANGLES CO TY AND TE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH I THE LEGAL OW OF, AN TEND TO DISCONNECT PLUG AND
RESIDE IN, THE V DESCRIBED RE TIAL P RTY.
ABANDON HOUSE SEWER
SIGNATURE roBACKFILLSEPTICSEPTIC TANKS ❑
OF PERMIT SEEP,PIS) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK M 0 �n�HSUPERVISING MECHANICAL ENGINEER
( &2 14 4',-Ir AUG 3 1 0 0 7.0 0