HomeMy Public PortalAbout5340 BUTTONS AVE_Sewer__ E-..3
S&E. APPLICATION FOR PERMIT _
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL '
Deportment of County Engineer =m=Em
County of Los AngelesBUILDING /� J /�
WM:J. FOX, COUNTY ENGINEER Com'_ Wim' ,
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN nEAREST /
CROSS ST.'ALL LS
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT 7 MAIL •�
ADDRESS
N0, OF BLOGS.
SIZE OF LOT NOW ON LOT CITY q` TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
CONTRALTO Kit , 0/„yK
'T1y 7
ADDRESS f CONNECTION DATA
CITY t TEL. NO. (p STATION 1-4 I DEPTH /
//��/�_�+ - •A ❑ STATE MANHOLE REFERENCE I / ^ UPPER
REGISTRATION N0. YGr. �J' ✓ .l
No. DESCRIPTION OF WORK FEE A
HOUSE SEWER CONNECTING TO TYPE OF CONNECTI LENGTH FROM
PUBLIC SEWER (Ty1 $ 3.50 Y. CURB P.L. M.L. TOP L
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB N0
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR GRAINFIELD .00 INDUSTRIAL
CESSPOOL-ORYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE TRACTORTTOB CONNECT THECTED ABOVEITH THE HEREIN DESCRIBED EXISTINGMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER -
SIGNED THIS— D F 19_- NEW HOUSE SEWER /
OWNER OR CONNECT ADDITIONAL 1 -Il'iaY
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP. PIT(S)
ADDRESS ANO/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
PLUMBING AND SEWERS. ER ALTER, REPAIR.SEWOR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL EM
ER
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIAL PROPERTY. ACKFILL SEPTIC TANKS❑
EEP. PIT(S) ❑ CESSPOOLS[ISIGNATURE
OF PERMITTEE
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
JC07 0 1 2 JUt!15 4 4.5 0