HomeMy Public PortalAbout9007 CALLITA ST_Sewer__ 10-63
76A64zD APPLICATION FOR �ERMI;Tro0 7
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COUNTY OF LOS ANGELES SEWER EWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION SUILDI NGS
JOHN A. LAMBIE. County Engineer AD pREss
WILLIAM A. JENSEN. Supt of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS STEGA
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DESCRIPTION
LOT NO. OWNER
BLOCK TRACT Z ADDRESS —/b �, „•i%, , ��
NO. OF SLOGS. \•. c�
SIZE OF LOT NOW ON LOT CITY [.J NO. S' y..,
BUILDINGS DISTRICT NO. GROUP I MAP PROCESS BY
/ � / '
CONTRACTOR SK PG
' VXry
ADDRESS /� �' A. CONNECTION DATA
CITY f S _ STATION DEPTH
TEL. NO.
L7 ® STATE MANHOLE REFERENCE �J ER
REGISTRATION NO.O S / [] COUNTY U
NO, DESCRIPTION OF WORK FEE TYPE OF CONNEC 10 LENGTH POM r
HOUSE SEWER CONNECTING TOY. CURB .L. M.L.TO .L. }
PUBLIC SEWER @ 85.00 V •J a
SEPTIC TANK,5EEPAGE PIT OR - P.C.NO. O
PITS AND/OR DRAINFIELD ® $10.00 CO.IMP. NO. JOS NO, u
HOUSE SEWER CONNECTING TO TPUNK PERMIT NO. ROAD PERMIT NO.�— ps
PRIVATE DISPOSAL SYSTEM @ $3.00 0
CONNECT ADDITIONAL BLDG. OR AFFIDAVIT [s[R[Mi RE�ORO. INSTR.NO. DATE FV
WORK TO HOUSE SEWER @ 3 U00 v
OVERFLOW SEEPAGE PIT.GRAINFIELD W
EXTN_CESSPOOL,DRYWELL.MAN H OLE @ 55.00
ALTER,flEPA1R OR ABA NOON HOUSE HWY.OR ST.WIDENING �1
SEWER OR DISPOSAL SYSTEM @ 33.00 , STATE ENCROACHMENT L
• PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT Sl 21 OD CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN IAMEO[CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS GATE INSPEC- R' SIGNATURE
SIGNED THIS DAY OF-19—
OWNER
F19_OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL If
BVILDING OR WORK
ADDRESS
SEITK�I HEREBY ACKNOWLEDGE THAT I' HAVE READ THIS. APPLICATION AND/OR
GRA ANKIN
SEEP,PIT 151
qN0/OR DRAINFIELD
ANO STATE THAT THE ABOVE IE CORRECT AND AWS E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ pRYW ELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED 0Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV DESC 15E0 ESIDENTIAL PROPERTY.
A� ABANDON HOUSE SEWER
SIGNATURE �/� /// •�G �. Ls(s /
OF PERMITTEE fia"— I1 1GG BACKFILL SEPTIC TANKS �]
SEEP.PIT(51 ❑ CESSPOOLS ' r _ 1� �✓Y
VALIDATIr'a. wood
CK. M.o. cgsH SUPERVISING
MECHANICAL ENGINEER
LAUD 2 4 9 7:E jil 3 1 0 D 7.0 0