HomeMy Public PortalAbout10627 BOGUE ST_Sewer__ CEBOS-8•b8 APPLICATION FOR PERMIT
E608-8COUNTY OF LOS ANGELES
SEWER-SEWAGE ISP®SAL �
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �I /) d ��
ADDRESS O� (/
JOHN A. LAM M County EngineeiI NEAREST.
_ ��
CASSATT D. GRIFFIN, Sup't of Building LOCALITY ,
FOR APPLICANT TO FILL IN •
CROSS ST.
LEGAL yT
DESCRIPTION LOT NO. OWNER �Tmtj=g Le
BLOCK TRACT MAIL
ADDRESS
N0. F BLDGS.
SIZE OF LOT NO ON LOT A CITY TEL.NO.
USE OF I
__.BUILDINGS DISTRICT N0. GROU MAP. PRO.USSED BY`�-/
CONTRACTOR: r K
ADDRESS •_...y i CONNECTION DATA '.l✓
CJ �Ii�-Lti TEL. NO. STATION V. „ DEPTH
f O TATE MANHOLE REFERENCE 1'� UPPER
REGIS ATION NO. I COUNTY ♦L 7'
NO. DESCRIPTION'OF WORK FEE
HOUSE
SEWER
EECONNECTING TO
PUL @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION/------,, LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD ,7 0
EX TN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. NO. J
• PRIVATE DISPOSAL SYSTEM @ $1.00 CO.1 0. JOB N0.
CONNECT ADDITIONAL BLDG.OR C_: TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER�OREPAIR OR R DISPOSAL SYSABANDON
HOUSE @ $1 OO STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
.,OWNER'S PEST $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE e U REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. _ APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
C� NEW HOUSE SEWER
SIGNED THIS Al' OFL�T!-� � t 19 CONNECT ADDITIONAL
OWNERS AGENT• 'Y'�' le-c"
OWNER OR �.�(-fi::k (((I--/�Yse Ae BUILDING OR WORK d
L
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER,,
CALIFORNIA OR THAT 1 AM TH EGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA6,gROPE BACKFILL SEPTIC TANKS❑
SEEP.PITS) ❑ CESSPOOLS❑
SIGNATURE
OF PERMI
®: VALIDA ROBERT A.WOOD
CE, d.0 CAS SUPERVISING MECHANICAL ENGINEER