HomeMy Public PortalAbout5330 BUTTONS AVE_Sewer__ 'f
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6APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING �"3'
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROS si.
LEGAL ti' "OWNER
DESCRIPTION LOT NO.
MAIL'
BLOCK TRACT .ADDRESS
N0. OF BL %'.CIT,' TEL. NO. '
SIZE OF LOT NOW ON LOTT
USE O
BUILDINGS / eF .% t.DISTRICT NO. GROUP MAP
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BK PG
CONTRACTOR t 'S r
ADDRESS /_{J� /�A� A� LL COLLDEPTHNNE TION DATA
car. STATION -T I' ' n
CITY
/' / TEL. N/O� . LO
MANHOLE REFERENCE
REGISTRATION NO. STATE Y WER
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y- CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ 5 3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO.37S3
3
EXTN..CESSPOOL,DRYWELL,MANHOLE @ S 2.00 CO. IMP. NO. dOCNO.
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 @ $.1.00 PERMIT N0.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ §1.00 WASTE APPROVAL
CHARGES
1
CONNECTIOJYCHARGE FEE
OWNER'S PERMIT g 1 DD
AUTHORIZATION TOTAL FEE Al
REIMBURSEMENT FEE
1 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. NEW HOUSE SEWER
SIGNED THIS�B>/),/�gF 19 CONNECT ADDITIONAL
OWNER OR !!�//////�/ BUILDING OR WORK
OWNERS AGENT it / 3��
/ - SEPTICTANK.SEEP,.PIT(5)
. ADDRESS AND/OR GRAINFIELD
1 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 AND
DISCONNECT PLUG
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HO PLUGUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE - SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER P XALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CH. N.0. CASH
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455� JAN 2 9 4 4.5 0 to