HomeMy Public PortalAbout6252 BURTON AVE_Sewer__ 7OA642DAPPLICATION FOR PERMIT
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COUNTY of Los ANGELES 7 SEWER—SEWAGE DISPOSAL +Ili
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION i
ADDRESS
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JOHN A. LAMBIB, GOvn1Y En9lnoa[ > '
CASSATT D. GRIFFIN. Suet of Building LOCALITY 4,AyNEAREST
po�`�LC•
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL � � A
DESCRIPTION LOT NO. OWNER �.�67!
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BLOCK TRACT CJ`�3 MAIL
ADDRESS
NO.OF BLOGS. ^ //�� Q
SIZE OF LOT NOW ON lOT CITY.t i � TEL. NOSL
USE OF �/ d ' -"
BUILDINGS ! /I .DISTRICT N0. GROUP MAP P CESSED
CONTRACTOR C BK'- PG
ADDRESS -� J - CONNECTION DATA
�L. N0. STATION ' Q DEPTH j6 STAIL /
o REGIST AT10 'NODI B COUNTY .MANH04-FERENCE / ^ UPPE
NO. RIP ION RfZLNORK FEE —� Ram
{� J
HOUSE SEWER CONNEWTING TO
PUBLIC SEWER ® $5.00
SEPTIC TANK,SEEPAGE PIT OR 7ypE OF CURB CONNECTION .L. M.LTO P.L.LENGTH FROM O
(Y . _
PITS AND/OR DRAINFIELD IN $5.00 \`
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWELL,MANNOLE N $2.00
HOUSE SEWER CONNECTING TO P.C. NO. -
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER a $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STA ENCROACH HENT
SEWER OR DISPOSAL SYSTEM $1.00 PERMI
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVIINER'S PST $ 2 00 O.ONNECTIO ARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 LS HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVADATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF-19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL:
OWNERS AGENT BUILDING OR WORK /
SEPTIC TANK,SEEP,PIT(S)ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ]('
'WAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRTWELL❑WITH ALL COUNTY
PLUMB NG AND SEWERS.INANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPER T REGISTERED AND/OR DISCONNECT PLUG AND ,T
LICENSED AS REQUIRED BY LOS A GELE COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM TH GA 0 HER OF THE
ABOVE r
DESCRIBED RESID YkA L'PROPE A SEEP.BACKFPIT SEP❑C CESSPOTANKS OLS
SIGNATURE
OF PERMITTE
®C ATIOROBERTA.WOOD
OL H, �cAyBt SUPERVISING MEGNMICAL ENGINEER
LACo 3 6 2 9 OCT 6 1 0 A 5 .0 0