HomeMy Public PortalAbout5938 BURTON AVE_Sewer__ D
sa E-6S420 11.55 APPLICATION FOR PERMIT
5&
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depm'tment of County Engineer
County of Los Angeles BDIE
DING �--
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESB
® CASSATT O. GRIFFIN. SUPT of BUILDING LOCALITY
FOR APPLICANT TO FIL Ir CROSS ST. P�
LEGAL / OWNER
DESCRIPTION LOT N0. % _
BLOCK TRACT t�3 MAIL
ADDRESS,
NO. OF BLOGS. / CITY �` TEL. N0.
SIZE OF LOT_�O Z NOW ON LOT I 7
USE OF
BUILDINGS DISTRICT NO. GROUP /gy MAP
CONTRACTOR
I � �
ADDRESS 6 CONNECTION DATA
STATION DEPTH
CITY TEL. NO. MANHOLE REFERENCE S'O _ UPPER
Jy�STATE E
REGISTRATION NO. /�I COUNTY
NO. DESCRIPTI N OF WORK FEE
_ TYPE OF TION LENGTH FROM G9 r
HOUSE SEWER CONNECTING TO Y. URB P.L. M.L. TO P.L. .JE J .
PUBLIC SEWER @ $3.50
_ r
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. N0.
? EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $ 2.00 CO. IMP. N0. JOB NO.
HOUSE SEWER CONNECTING TO. ��n
PRIVATE DISPOSAL SYSTEM. @ $1.00 . TRUNK PERMIT N0, ROAD PERMIT NO
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER O $ 1:00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM r(y $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE.
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED coN- APPROVALS DATE INS PECTOR'S SIGNAT URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER !_ NEW HOUSE SEWER
SIGNED THIS SAY OF �--- 7Y+ CONNECT ADDITIONAL 0f(1
OWNER OR _ BUILDING OR WORK
OWNERS AGEN SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL❑
AND 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. ALTER,
DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE OF g DISCONNECT
HO PLUGAUSE D n
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE ABANq
DESCRIBED RESIDENT PROPERTY. BACKFILL SEPTIC TANKSTLl
K /
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS EC ,
OF PERMITTEE / PV
JOHN A. LA IE. C NTY ENGINEER VALIDATIO ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
cK. e.o. cnsR
(,AC01.5'3 ;5"�. FEB 26 4 A 450 n