HomeMy Public PortalAbout9008 CALLITA ST_Sewer__ J
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APPLICATI�R PER[T -
]6A 6420 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION eu 1LDINc
JOHN A. LUMBI E. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO FILL MR.
BE- ST.
LE
GAL
DESCRIPTION LOT NO. 12, OWNER
c MAIL
BLOCK TRACT �J Z 2— ADDRESS
NO. OF ELDON.
S13E OF LOT NOW ON LOT CITY TEL, NO.
USE OF
BUILN \ DISTRICT NO. GROUP MAP PRO SSED BY
DIGS
CONTRACT R /O BK _ / o
ADDRESS
'41�/ (y/( CONNECTION DATA
_ S STATION _5 DEPTH
CITY TEL, NO.
STATE NO, [LA38 MANROLE REFERENCE
O•� LOWER
NO. bEscF6PTiCN OF WORK FEE TYPE OF CONNECTIONLENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.0 M.L.TO P.L.
PUBLIC SEWER Q .00
SEPTIC TANK,6EEPAGE PIT OR P.C.NO.
PITS ANO/OR ORwINFIELO SIO.00 CO. IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 7'
PRIVATE DISPOSAL SYSTEM Pt? 53.00CD
d
CONNECT ADDITIONAL BLDG.OR AFFIDw VIT AiV [5[Y[ RECORD,INSTR.NO. DATE
WORK TO HOUSE SEW E R S3.GO
OVERFLOW SEEPAGE PIT.GRAINFIELD
EKTH.,CESSPOOL.DRYWELL.MA NHOLE S'GO
I=®
ALTER.REPAIR OR ABANDON HOUSE HWY.OR BT.WIDENING V
SEWER OR DISPOSAL SYSTEM ® $3.00 STATE ENCROACHMENT (L
PERMIT NO. V]
INOU5TRIAL Z
WASTE APPROVAL
CHARGE.
OWNER'S PERMIT s o0
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR T0.CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE ! INS /.C1TORR''S,SIGNATURE
SIGNED THIS / DAYF,S�19
OWNER A / \ NEW HOUSE SEWER
AGENT
OWNERS
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT 151
PNO/OR GRAINFIELD
AND .TATE THAT TME ABOVE t5 CORRECT ANO AGREECOMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REE GULATING
PLUMBING /NO SEWERS. CESSPOOL ❑ DRV WELL ❑
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE OVE D CRIBEO ESLD IAL PROPE TY.
ABANDON HOUSE SEWER
SIIla-
GNATURE BACKFILL.EPTIC'11'1=911
ANKS ❑ _
OF PERMTITE
BEEP.PIT ISI ❑ CESSPOOLS ❑ -z
VALIDATION JACK R. ALLEN
cK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
Ij--.'-3
l^.. 2 4 7 573 JLL27 1 0 D 1 0.00