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HomeMy Public PortalAbout5349 BUTTONS AVE_Sewer__ ^ Ca SE.(21911�94 APPLICATION FOR PERMIT 5 k -DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County Of Los Angeles BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPTOP BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS si LEGAL . OWNER OESC A DESCRIPTION LOT N0. MAIL BLOCK TRACT ADDRESS N0. OF BLOTS. SIZE OF LOT OT CITY r TEL. NO. NOW ON L _ USE OF BUILDINGS DISTRICT NO. GROUP MAP G'�� PG CONTRALTO 541W _ _Irk ��/ ADDRESS – 1 B - C� CONNECTION DATA (—� ��h'`J n _yr STATION DEPTH CITY TEL. NO . f (- MANHOLE REFERENCE //-7 ❑ STATE , REGISTRATION NO. G NO. DESCRIPTION OF WORK FEE TYPE OF CON NECTIO LENGTH FROM HOUSE SEWER CONNECTING TO y� p,L M.L. TO P.L. , _J PUBLIC SEWER @ $3.50I t,.J � SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD © $3.00 Q� OVERFLOW SEEPAGE PIT.DRAINFIELD CO. IMP. NO. PYeitlT `J 7 C3 OVERFLOW OW SEEPAGE YWEL L,MAN ISLE (ry $ 2.00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM © $1.00 TR UN( PERMIT N0. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ROACHM ENT WORK TO HOUSE SEWER @ $1.00 PERMIT N0. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM rPJ $$1.00 WASTE APPROVAL CHARGES CONNECTION CHA FEE OWNER'S PERMIT a 1 00 REIMBURSE T FEE AUTHORIZATION TOTAL FEE L 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON. A ROYALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r� TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS ig— CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) '. ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 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 NTY AND STATE OF AB CALIFORNIA OR THAT I AM THE LEGA W ER OF THE ASO V ANDON HOUSE SEWER DESCRIBED RESIDE TIAL PRO E Y. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS OF PERMIT JOHN A. LAMBIE. COUNTY ENGINEEW LIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR C M.0. CASH f 2zo .3 MV 9 4 4.50