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HomeMy Public PortalAbout5327 BUTTONS AVE_Sewer__ 0AB420 6 APPLICATION FOR PERMIT 1 °G4 9 11�55 NVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING ✓p� 7 JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J' J © CASSATT D. GRIFFIN. SUPT Or BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT N0. OWNERMAIL BLOCK TRACT JC/ �/ 7 ADDRESS (J�— NO. OF BLDGS. / EPERM TEL. N0. SIZE OF LOT NOW ON LOT USE OF TRICT NO. GROUP MAP BUILDINGS .Q� I BK PG CONTRACTO �� �� / 7 ADDRESS CONNECTION DATA,ON 5 , DEPTH�7 / /' OLE REFERENCEREGISTRATION N0. IK } / � ��Y� if No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3.50CURB P.L. M.L. TO P.L. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ S 3.00 ��L®+C./L�IOVERFLOW SEEPAGE PIT. DRAINFIELDP. C. NO. 3 � 3EXTN_CESSPOOL,DRYWELL,MANHOLE @ $2.00P. NO.HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 PERMI 0. ROAD PERMIT NCONNECT ADDITIONAL BLDG.OR ENCROACH T WORK TO HOUSE SEWER @ $1.00T NO. ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $100 WASTE APPROVAL CHARGES CONNECTIO HARGE FEE OWNER'S PERMIT S 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- APPROVALS DATE INCZ PECTOR'S SIGNATU RE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING t01 TO THE PUBLIC SEWER. NEW HOUSE SEWER - SIGNED THIS—D 19_ CONNECT ADDITIONAL ' OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS100f4AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ 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 AND LICENSED AS REQUIRED BY LOS ANGELES CO NTY AND STATE OF ABANDON HO PLUGAUSE D CALIFORNIA OR THAT I AM THE LEGAL N R OF THER E ABOVE DESCRIBED RESIDEN L PROP RT BACK FILL SEPTIC TANKS❑ SIGNATURE $AEP. PIT(S) ❑ CESSPOOLS❑ OF PERMI JOHN A. LAMBIE, COUNTY ENGINE LIDATION ROBERT A. WOOD.CHIEF PLBG. INSPECTOR CN. U.0. CASH (Y2201 110 9 4O 450 In