HomeMy Public PortalAbout5946 BURTON AVE_Sewer__ D
Z. -663399 APPLICATION FOR PERMIT
8&E-6
DIVISION OF BUILDING AND SAFETY SEWER®SEWAG DISP SAL
Deportment of County Engineer - ' •-
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
_ f
C_A63ATT D.GRIFFIN, 3UP'1 of BUILDING LOCALITY Ipl . , C
FOR APPLICANT TO FILL IN
NEAREST.
LEGAL -
DESCRIPTION I LOT NO. 1GY iT.f OWNER
BLOCK TRACT ® MAIL
ADDRESS � Y s
I �, �Av NO. OF SLOGS. ^�
SIZE OF LOT �DQ 9W NOW F LOT .F CITYhI TEL. NO
USE OF
`
BUILDINGS � �aL4> DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR rp A'_ 64-
ADDRESS
4ADDRESSS 5?Ok 41 3 ,Cl J�. 1 CONNECTION DATA
CITY •8�TEL. N0. 9 -6-97'.30 STATION / T 6!i DEPTH
y y ❑ STATE MANHOLE REFERENCE �J Z UPPER
REGISTRATION NO. Q ❑ COUNTY
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FR
HOUSE SEWER CONNECTING TO P.L." y
PUBLIC SEWER Q $ 3.50 Q Y. CURB P.L. M1f L TO P L !/
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 9//,
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. 13 V JOB NO.
ALTER OR REPAIR NG /a/O 30
AL VER R DISPOSALL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00 -
INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT - CONNECTION CHARGE FEE
OWNER'S s 1 pp00
AUTHORIZATION TOTAL FEE p� REIMBURSEMENT FEE
I HAVE DATETRACTORTTOS CONNE TOCTED THEAABOVE DESCRIBED EK6TINGWIT" THE HERNpMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC S''EW''ER
SIGNED THIS I DAY OF s�m19,f4 NEW HOUSE SEWER
OWNER OR 11 a / / sem CONNECT ADDITIONAL
OWNERS AGENIT BUILDING D WORK
ADO,ESS- 1 a SEPTIC TANK, SEEP, PIT(S)
1 ANO/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AWLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER. REPAIR, SEWER OR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
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 SEW EP.
DESCRIBED RESIDENT IA PROPERTY. BACKFILL SEPTIC TANKS❑
2 SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A. WOOD. CHIEF PLBG. INSPECTOR
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29- ;,IJG 14 4 4. .5