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HomeMy Public PortalAbout10628 BOGUE ST_Sewer__ �Q S&E-889 11.85 a _-- APPLICATION FOR PERMIT 1 S$E DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING D R JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL OWNER ' DESCRIPTION LOT NO. MAIL BLOCK 'TRACT — �� ADDRESS N0. OF BLDGS. CITY TEL. NO. SIZE OF LOT NOW ON LOT USE OF DISTRICT GROUP MA BUILDIN .I c-.�J7�{ I E3 BK (a/•PG CON "� ' ADDRESS CONNECTION DATA CI TEL. N0. STATION ''�9 ;�` DEPTH (+^ yy ,�, � MANHOLE REFERENCE - _ _ PPE ATE REGISTRATION NO.,� �.�] [I OUNTY - _ NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGT FROM PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. T P.L. SEPTIC TANK,SEEPAGE PIT OR - PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. N0. © 6 EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 = CO. IMP. N0. Jii&.AL6r v HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT-NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PERMIT g t 00 AUTHORIZATION TOTAL FEE d REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS _ DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOV DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS D OF 19CONNECT ADDITIONAL OWNER ORBUILDING OR WORK OWNERS AGENT—IA SEPTIC TANK•,SEEP,PITS) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELLE] AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1HEREBY 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 I AM THE LEGAL OWNEROF T ABOVE DESCRIBED RESID IAL PR PERTY. -' BACKFILL SEPTIC TANKS T( '44SEEP.PITS) ❑ CESSPOOLS❑ OF PERMITTEE ' JOHN A. LA E, COUNTY ENGINEER VALIDATIOa-.., ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK. M. 0. CASH - - - I� 13251 FEB 1-7 4 A 4-50 M