HomeMy Public PortalAbout5320 BUTTONS AVE_Sewer__ 7e^04203 11.53 — —APPLICATION FOR PERMIT
e&EOeDIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer '
County of Los Angeles BUILDING j^
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS _ j
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
+ DESCRIPTION LOT NO 1%
MAIL
BLOCK TRACT +'��� ADDRESS \ ^�� .�!�T/i--• ,� /nn
NO. OF BLT CIT f, 1 _ L� L. NO. S,:Ci:�j •f
SIZE OF LOT NOW ON LOT
USE OF DISTRICT N0. GR P MAP
BUILDINGS
s BK PG
CONTRACTOR 4.. ..._ 'J µ
ADDRESS � CONNECTION DATA
t STATION DEPTH 16
CITY_" TEL. N0. �� ��'
MANHOLE REFERENCE /
[iPPER
STATE
REGISTRATION NO. ❑ COUNTY
NO, DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM A
HOUSE SEWER CONNECTING TO ) y, CURB M.L.T, P.L. Q
PUBLIC SEWER @ $3.50 �—
SEPTIC TANK,SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD CU $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD + *O P�� j j
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ S 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 7 OO
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
i SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[I -
AND STATE THAT THE ABOVE 15 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 1 AM PROPERLY REGISTERED AND/OP DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER 0,F THE ABOVE
DESCRIBED RESIDENT PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE"
JOHN A'. LAMBIE. COUNTY ENGINEER ALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CASH
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22 3 70R M425 4 A 450 2