HomeMy Public PortalAbout10640 BOGUE ST_Sewer__ 7GA643D
5 6-663 3.55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer r
ILDING `'
County of Los Angeles DRESS ]Ob!rO BOLile St_
WM.J. FOX, COUNTY ENGINEERCASSATT D.GRIFFIN, SUPT OF BUILDING CALITY tl em-ni P. Ci tir
FOR APPLICANT TO FILL IN CROSS ST. T.;,•.c`Calf nvo
LEGAL
DESCRIPTION LOT NO. 2' OWNER MMAIL iller and Price-
BLOCK
rice•BLOCK TRACT Tf�act 17158 ADDRESS c�0•-PO }j. Las Tl nA.R DY'NO OF �
SIZE OF LOT 50 x 156 NOONBLOTS
W 1 CITY TEL N0.
USE OF
BUILDINGS I P' DISTRICT N0. GROUP 'MAP
PG
— BK
CONTRACTOR
ADDRESS CONNECTION DATA
CITY' -TEL. NO. STATION DEPTH
❑ STAT MANHOLE REFERENCE / , UPPE
REGISTRATION NO. ❑ COUNTY IP NO. DESCRIPTION OF WORK FEE
�
HOUSE SEWER CONNECTING TO TYPE OF CONNECTI LENGTH FROM.
Y� . CURB P.L. IA.L. 70 P.L.PUBLIC SEWER Q $ 3.50 A _
HOUSE SEWER CONNECTING TO
"PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. .105.#0.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE-FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION TOTAL FEE q— 5-7) REIMBURSEMENT FEE
I HAVE TRACTORiTOS DATE CONNECT THEACTED ABOVEWITH THE DESCR DESCRIBEDEREIN EXISTING DWED CON-
ELLING NG APPROVALS DATE INSPECTORS SIGNATURE
TO THE-PUBLIC SEWER -
SIGNED THIS DAY OF 19_ NEW"HOUSE SEWER ���g0� �
OWNER OR CONNECT ADDITIONAL ry
OWNERS AGENT _ BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
_ ADDRESS AND/OR DRAINF)ELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL ElAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/CR
LICENSED AS REQUIRED BY LOS ANGELES CO TY AND STATE OF .DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL O ER OF THE A OVE ABANDON HOUSE SEWER
DESCRIBED RESIDE- _ BA-CKFIL-L--SEP_ [ISIGNATURE TIC TANKS
; SEEP.PIT(S)PT CESSPOOLS{] _
`� r ( _
OF PERMITT E - '
WILLIAM J.FOX.COUNTY ENGIN VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
4.5 U
�,Co 2 5 8 2 MOV�0 4 . �