HomeMy Public PortalAbout5352 BUTTONS AVE_Sewer__ TBA APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County EnL
County of Los AngeleBDILDING ?
WM.J. FOX, COUNTY ENADDfl E55 •/
CASSATT D. GRIFFIN, SUPT OFNG LOCALITY
FOR APPLICANT TO FILL IN CROSS S
LEGAL T. �i{ L • rw{
y/
DESCRIPTION LOT N0. .rC OWNER
BLOCK TRACT MAIL .ya
ADDRESS C C_
NO. OF BLDG$.
SIZE OF LOT NOW ON LOT / CITYA A" TEL. N0,
USE OF
BUILDINGS (it+� DISTRICT N GROUP MAP
DK PG
' CONTRACTOR �! � �i � �.. I = p 5� _
ADDRESS `JF ' (.�, c CONNECTION DATA
CITY ��fL.��..� %� TEL. NO. C.(� STATION DEPTH
y ❑ STATE MANHOLE REFERENCE
REGISTRATION NO. L/ h ❑.1AUMFY- UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO _ /I
HOUSEPUBLIEWR CONNECTING TO Q $ 3.50 pn'�Y�LfJOJT-
HOUSE SEWER
PRIVATE DISPOSAL SYSTEM 1.00 __
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. JOB. NO.
' WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK. SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL -- WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CH GE FEE
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE C014TRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE lSPECTOR*S SIGNATURE
TO THE PUBLIC SEWER -
SIGNED THISDA' 19 'NEW HOUSE SEWER ` DA�,•^��e
OWNER OR _ J CONNECT ADDITIONAL ,
OWNERS AGENT J-�� BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYWELL❑
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 O
DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
` SEEP.PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION .
���o 5 1 4 2 L APR 16 4 2 .0 0
:By BY
DEPUTY DEPUTY
BY BY
(9) DEPUTY DEPUTY 4e _'PUTY -