HomeMy Public PortalAbout6230 BURTON AVE_Sewer__ CEBOB3.B2 76A6420 APPLICATION FOR PERMIT
CT OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING
JOHN A. LAMBIE, County Engineer ADDRESS 6230 Burton
WILLIAM A. JENSEN, Supt of Building
LOCALITY San Gabri el
NEAREST
FOR APPLICANT TO FILL IN CROGG ST. Lo don
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT 5903 ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF �N
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR H Williams
il liams � ♦�
ADDRESS 2315`E. 118 Ste CONNECTION DATA
CITY a +eC,ON O. 1.06460 STATION l ^ DEPTH
UPPER
REGISTRATION NO.
(11 139099 ❑ STATE COUNTY MANHOLE DEFERENCE J:l/ LOWER
NO. DESCRIPTION OF WORK FEE TYPEOFCON NECTION •LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB ,L. M.L.TO P.L. '
PUBLIC SEWER @ $5.00 RQ NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS ANO/OR ORAINFIELD @ $1000 CO. IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT NO. O
PRIVATE 015POSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT uv 5[x[x RECOftO.INSTR.NO. GATE
WORK TO HOUSE SEWER @ 53.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
E%TN_CESSPOOL.DRYWEI L.MANH O LE@ $5.00 VJ
ALTER.REPAIR Ofl ABANDON HOUSE HWY.OR ST.WIDENING a
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s __2T11
' AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAV OF 19_
OWNER - _ NEW HOUSE
A R
JJ44/Jll aVT�
OWNERS AGENT_ , CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIEL OTANK.SPIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY NO� IELD
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY ANO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV D SCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATUREBA.KFILLSEFT1C TANKS ❑
OF PERMITTEE `H ❑
SEEP.PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
CK. M,IT ASH SUPERVISING MECHANICAL ENGINEER
LitGD5 3 1 6, N4 28 1 0 A .00, e