HomeMy Public PortalAbout6254 BURTON AVE_Sewer__ °
moa- APPLICATION FOR PERMIT .
cseoe.eae COUNTY OF LOS ANGELES
SEWER-SEWAGDISPOSAL
DEPARTMENT OF COUNTY ENGINEE6 � "
BUDDING ANDSAFETY DIVISION - BUILDING _
JOHN A. LAMBDRESS IE. County Engineer AD /i
CABBATT D. GRIFFIN, Supt of Building LOCALITY . �.ZG� •%� � , /
. ,. ._,._.. NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL L�
DESCRIPTION LOT NO. DWNE
BLOCK TRACT MAIL
BLDGADDRESS !I
SIZE OF LOT/6 C NOWOON LOTS ':N0.
USE OF
n. ,4
BUILDINGS DISTRICT NO.11 GROUP � MAP P OCESSED Y
CONTRACTOR OK PG !,
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ADDRESS CONNECTION DATA
CITY TEL.NO. STATION j f6 DEPTH A
}/ TATE MANHOLE REFERENCE 4V 42210•
REGISTRATION NO. -/ COUNTY
No. DESCRIPTION OF WORK FEE 1'0()
r•�
HOUSE SEWER CONNECTING TO (%
PUBLIC SEWER @ ;9.00 TYPE OF CONNECTION LENGTH FROM
PETS IAND/OR ORRENFGELDIT OR @ ;3.00 Y. CURB P.L. M.L.TO P.L. O r
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ ;2.00 1�
HOUSE SEWER CONNECTING TO P.C. NO.
PRIVATE DISPOSAL SYSTEM @';1,00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD MIT N0.
WORK TO HOUSE SEWER ® ;1.00
ALTER,REPAIR OR ABANDON HOUSE STATE'rNGR HENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PST S 2 00 CONNECTI ! CHARGE FEE
AUTHOREZATION1. TOTAL FEE 1 5 0b IREIMIrURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE. INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY O Ig_ NEW HOUSE SEWER -
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT V BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELEA COU NTT AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT M"'THE GAL OWNER OF THE ABOVE
p
DESCRIBED REST NTIA PROP BACKFILL SEPTIC TANKS ❑
SIGNATURE /,(� - .SEEP. PITS CESSPOOLS
OF PERMITTF
ALIDATIOA ROBERT A.WOOD
Au. B.A. CASN SUPERVISING MECHANICAL ENGINEER
LAI3 6309; OCT 61- 0 A 5.0 0