HomeMy Public PortalAbout5323 BUTTONS AVE_Sewer__ 96A84APPLICATION FOR PERMIT
9eE60DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer -
County of Los Angelesam LDING
.JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 7"L4-1
® CASSATT B. GRIFFIN, SUP-TOF BURairva LOCAIITT
... .. -
FOR APPLICANT TO FILL IN CROSS ST.
' LEGAL OWNER
[ DESCRIPTION LOT N0.
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BLOCK - TRACT 7 -'.ADBRESS
SIZE OF LOT C O X C C.2 NOW ONSLOGLOTS CIT • e TEL. NO.
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CONTRACTOR ,et, �f
ADDRESS 91- sA�/J-c. u. -'-'��-L._.Q CONNECTION DATA
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FERENCE DEPTH
CITY . NO.
REGISTRATION NO. 6/ J "L••-_ ❑i1 TY - •�STATE -7141I-ACZX LOWER
` NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB ,? M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MAN HOLE @ $2.00 �• � �t ��•��
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT-
WORK TO HOUSE SEWER @ $LOG PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM cu $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'$SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING t
TO THE PUBLIC SEWER. _ NEW HOUSE SEWER ,ISS
SIGNED THIS�n��jF 19 CONNECT ADDITIONAL
OWNER OR y // /% BUILDING OR WORK
OWNERS AGENT //// Y SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DPYW ELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES COUNTYO
AND STATE OF - ABANDON HOUSE SEW
` CALIFORNIA OR THAT I AM THE LEG W ER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL PR P TY. BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP. PIT($) ❑ CESSPOOLS❑
OF PERMIT
JOHN A. LAMBIE. COUNTY ENGI ER /ALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
LAD 5 6 9 1 MAR 1 4 4.5 0 In .