HomeMy Public PortalAbout5353 BUTTONS AVE_Sewer__ '�T6Aeax0 APPLICATION - FOR PERMIT Il
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer �J
County o1 Los Angeles AODREs9
WM. J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN. SUP'r of BUILDING LOCALITY
FOR APPLICANT TO FILLIN NEAREST
CROSS ST. C
LEGAL i
DESCRIPTION LOT NO OWNERkik, 1
BLOCK TRACT � MAIL
/
N0. OF BLDGS.
SIZE OF-LOT _ NOW'ON-LOT- - CITY TEL. NO.
USE OF
BUILDINGS 9 DISTRICT NO. GROUP MAP
CONTRALTO G! //Iiy ` D 1
SK RD
ADDRESS s � iV / �;v CONNECTION DATA 1/ f+ If
CITY 2 :��-�" TEL. NO. C ` 3Y STATION /3 '�'Z DEPTH
❑ STATE MANHOLE REFERENCE
REGISTRATION N0. 7 �' ❑c98riM.T�Y LOWE
TYPE OF CON NECTIGL. LENGTH FROM
NO. DESCRIPTION OF WORK FEE y� &2i ` M L TOP L
HOUSE SEWER CONNECTING TO
PUBLIC'SEWER Q S 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT 0.001BLDG. OR
WORK C HOUSE
SEWER 1.00 CO. IMP, NO. '/��dZ JOB, NO.
_ SEWER
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO, ROAD PE NO.
DISCONNECT AND ABANDON SEVIER ROACHN ENT
AND/OR DISPOSAL SYSTEM 1.00 PERh11T N .
'SEPTIC TANK, SEEPAGE PIT OR
_ 'PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECT CHARGE FEE
OWNER'S PERMIT 5 1 00
AUTHORYZATION TOTAL FEE R RURSEMENT FEE
1 HAVE-THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- - l
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE, IN PECTOR'S SIGNATURE
,TO THE PUBLIC SEWER
SIGNED THIS 19_ NEW HOUSE SEWER 101
OWNER OR / _) 'CONNECT ADDITIONAL
OWNERS AGENT J— _BUILDING OR WORK
ADDRESS SEPTIC TANK. SEEP, PiT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE HAT 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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. - BACKFILL SEPTIC TANKS❑
j SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE ef
WILLIAM J. FOX, COUNTY ENGINEER - VALIDATION
i,t IC,0 5 1 4 1."' APR 16 4 4.r5 Q
BY
DEPUTY DEPUTY
,.BY BY
.�®
DEEM ��� DEPUTY