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HomeMy Public PortalAbout5942 BURTON AVE_Sewer__ E9e 8& .B69 9.95 APPLICATION FOR PERMIT B 6 DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer .. `/ :/I ., �"�.._ .} .. County of Los Angeles pp RESSG I `'iP WM.J. FOX.COUNTY ENGINEER CASSATT 0. GRIFFIN,SUPT OF SulLmnc LOCALITY r4a_, -/ r& Jhhltt + �G:Xn<..I FOR APPLICANT TO FILL IN CROSS ST. _ LEGAL DESCRIPTION( LOT NO. �� X2_0 OWNER BLOCK I TRACT® MAIL `y .✓� ADDRESS ?J Y b NO. OF BLDGS. SIZE OF LOT(/15,1.- X190 NOW ON LOT �4 CITY ,u,47ef,�%, TEL. NO. A 1 USE OF INGS a^�.ir>Cl�'Ca1l� BUILDINGS } ,� e DISTRICT NO. GROUP MAP BK PG CONTRACTOR e.. f � '!3 �5 t= (0+ ADDRESS a per , CONNECTION DATA CITY � _��� +TEL. NO. 94 ' IC � STATION 14-+0 , ( DEPTH REGISTRATION NO. 1 3 / / ❑ COUNTY 49�0` STATE MANHOLE REFERENCE / cO�� UPPE No. DESCRIPTION OF WORK FEE lJ aJ HOUSE SEWER CONNECTING TO TYPE 0 NECTION LENGTH FROM n 11 //�� � Y. CURBJ P.L M L. TO P.L. L G PUBLIC SEWER © S 3.50 cO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 _ CONNECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER 1.00 OD CO. IMP. NO. i [lJ JOB N0. ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NO. _ SEWERALTER R DISPOSAL SYSTEM 1.00 DISCO14NECT AND ABANDON SEWER STATE ENCROACHMENT --r AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRA INFIELD .00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES PERMIT CONNECTION CHARGE FEE OWNER'S S I 00 . AUTHORIZATION TOTAL FEE S SO REIMBURSEMENT FEE I HAVE TRACTORTTOS DATE CONNECT THEACTED ABOVEWITH THE HEREIN DESCR BED EXISTINGMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURC TO THE PUBLIC ISIEW''ER � ,., SIGNED THIS�L DAY OF �-�' -=-+- NEW HOUSE SEWER lL y !P, OWNER OR I �47 -� +� `4 CONNECT ADDITIONAL OY/NEPB pA GyENT La+FA/ COILDINGNNECT D WORK ADDRESS^' ��_' 9Y .��.//.I/=-. + /� SEPTIC TANK, SEEP, PIT(S) P 6� AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ 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. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER. DESCRIBED RESIDENT IA P OPERTY. BACKFILL qw� CESSPOOLS // SIGNATURE OF PERMITTEE WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF FLBG. INSPECTOR