HomeMy Public PortalAbout10568 BOGUE ST_Sewer__ •18-63
76A66A64D
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 7ADDRESS
JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of BuildingFOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACTADDRESS O
NO OF BLD 5 -77'
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
BK PG (/^ (/ _
CONTRACT0oe D� I �` f 2J (/ Com-
ADDRESS CONINEECTION DATA
CITY TE STATION O v THSTATE L
REGISTRATION NO �� ❑ COUNTY MANHOLE REFERENCE���� T �C/ LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH OM
HOUSE SEWER CONNECTING TO LL Q� Y CURB P L M L TO P L. }
PUBLIC SEWER @ $5 00 V O(/
SEPTIC TANK,SEEPAGE PIT OR P.0 NO i• `� O
PITS AND/OR DRAINFIELD @ 31000 CO I.I. NO JOB NO. L/J / V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ S3 00 ^
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I wAIVEN EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT.DRAINFIELD W
EXTN,CESSPOOL.DRYWELL,MANHOLE @ E5.00 ` d
ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT G_ -
M;/tom PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERCHARGESS PERMIT S z oo C9--l'r ,e—-e,,
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE O
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNEROR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
1 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 ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT HE LEGA NE O AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A E D CRIBED DE I PROPERTY. ABANDON HOUSE SEWER
SIGNATURE ACKFILL SEPTIC TANKS ElOF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK M O CASH
SUPERVISING MECHANICAL ENGINEER
- ( 2 1 4 6%-a AUG 3 1 0 D 7.0 Or_, Kr