HomeMy Public PortalAbout5326 BUTTONS AVE_Sewer__ s C-863,11.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
ADDRESS 7 7 •TJ L/ /I S A I/�
JOHN A. LAMBIE. COUNTY ENGINEER ,
® CASSATT D. GRIFFIN. Sur'r oR 6UILOING LOCALITY JFJ � •�.
NEAREST
FOR APPLICANT TO FILLY IN�Ij/ /e 1 GROSS ST. t ///1 7/
LEGAL / / "LJ !'R��Y_ OWNER /K�bc_P / L�
DESCRIPTION LOT NO `` n1/ - of /GI
MAIL
BLOCK TRACq% /LLG1ji//C � AAIL
ODR�ESS
�S,S'Z.�� 7L46
/A �n 71. NF BLDG
OWOON LOT1 BUD S CIT' /•!_IAA A / TEL. NO.
SIZE OF LOT -
USEOF '
BUILDINGS bj e DISTRICT O. o ✓GROUP .MAP PG
1 G
CONTRACTOR
ADDRESS - may, ',./ / n A �� CO CTION DATA
STATION
CITlRt ib P `/ATEL. NO. 091 MANHOLE REFERENCE DEPTH
I /�
❑ STATE =2 / LOWER
REGISTRATION NO. ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM //�
PUBLIC SEWER @ SS Y. CURB P.L. M.LIL .TO P.L. N(l
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO. 7 f� (/
EXTN.,CESSPOOL,DRYWELL, @ S 2.00 CO. IMP. NO, lOB N0. 7 ` O
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $ 1.00 TRUNK PERMIT NO. ROAD-PERMIT-NO.-
CONNECT
OADPERMITNO.CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL _
'SEWER OR DISPOSAL SYSTEM @ $L00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT E 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE'
I HAVE AT THIS DATE A CONTRACT WITH THE-HEREIN NAMED CON- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING i
TO THE PUBLIC SE��W/EER11. CONNECT ADDITIONAL
NEW HOUSE SEWER O
SIGNED THIS_L.�DAY OF �'/�' -T� 9.1.1'
1 t _ „
OWNER OR�� Q �� � /� BUILDING OR WORK
OWNERS AGENT .1 �s SEPTIC TANK,SEEP,PIT(S)
ADORESS� 1 'L T.a , I / �i)4 S 1/ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AN 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COONTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THB ABOVE
DESCRIBED-RESIDENTIAL PROPER/T/Y. BACKFILL SEPTIC TANKS❑
SIGNATURE BEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEj;
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. Y.D. cc ASXf'�/
I" 5 4T �'010 A 5.00