HomeMy Public PortalAbout5331 BUTTONS AVE_Sewer__ 96A642OAPPLICATION FOR PERMIIT .
9 a E-663 11-05
DM$ION OF BUILDING AND SAFETY SEWER=SEWAGE DISPOSAL
Deportment-of County Engineer - - -
County of Los Angeles BUILDING-
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
tJ CASSATT 0. GRIFFIN. SUPT OF BUILDIN. LOCALITY
FOR APPLICANT TO FIL4INR
s"s si.
LEGAL ER
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT ��/� RN0. 0 RY TEL. N0.
SIZE OF LOT NOW ON LOTUSE OF ISTRICT NO. GROUPMAPBUILDINGS BK P, G
CONTRALTO � 1Y11---moi/ADDRESS ✓ CONNECTION DATA
STATION t 6 of O DEPTH
CITY t5j3�_ i TEL. NO. 1 � .J
MANHOLE REFERENCE '7
❑ STATE OC O\VEP
REGISTRATION N0. ,/3�/� e•� �� a-,ouuy -
No. DESCRIPTION OF WORK FEE
TYPE OFCON NECTI LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L M.L.TOP.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD CO. IMP. NO. oa-HC! -�
OVERFLOWS EEPAGE YWEL LMAN ISLE (g1 $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ 51.00 TRUNK PE O. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMEI
WORK TO HOUSE SEWER a $1:00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
HARGES
CONNECTION CHARG EE
OWNER'S PERMITS 1 00
AUTHORIZATION TOTAL FEE lJ REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAME) CON.' APPROVALS DATE INSP CTOR'S SI GNATURE•
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY O 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTICTANK,SEEP, PIT(S) _
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
-
LICENSED AS REQUIRED BY LOS ANGELES COON D STATE OF ABANDON HO PLUGAUSE D
CALIFORNIA OR THAT I AM THE LEGAL OW OF TH ABOVE
DESCRIBED RESIOENTI L PROP - BACKFILL SEPTIC TSNPO❑
SIGNATURE
SEEP.PITS) ❑ CESSPOOlS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER ^VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
�,�C✓ Y.O. CPSH
LG2 2 0 2 MV 9 4 •' 4.5 0 91
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