HomeMy Public PortalAbout9012 CALLITA ST_Sewer__ ,90AO42D APPLICATION1 FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depto en1 of County Engineer Wze_�
County of Los Angeles BUILDING
ADDRESS
WM. J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN. SUP'T OF BUILDING - LOCALITY
FOR APPLICANT TO FILL IN NEAREST
sT.LEGALDESCRIPTION LOT NO. OWNERBLOCK , TRAC/T/ j MAIL
ADDRESS
SIZE OF LOT "' '`/ ,3�NOWO. OON LOTS / CITY ( TEL. NO.
USE OF .O iA^7�y
BUILDINGS A�C ' � DISTRICT NO. GROUP EMAP
CONTRACTOR ��� Q 1/J \C/I C/ �•' I J_ - (� ��OG
ADDRESS 3 a7—//, // ''') CONNECTION DATA
�7 /(J
CITY, / �Y k TEL. NO. '
6 STATION x- D 1) DEPTH J 5�
/,6 q�� El
MANHOLE REFERENCE J /C f LOWER
REGISTRATION N0. COUNTY '
UPPER / /I (� /S
TYPE OF CONNECT I LENGTH FROM •
NO. DESCRIPTION OF WORK FEE Y. CURB .L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 ✓�
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT_ WORK TO HOUSEONAL SEWER CDG. OR 1 00 CO. IMP. NO. JOB. NO.
ALTER OR REPAIR EXISTING F-�
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
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 CHARGE
-- CONNECTION CHARGE FEE
OWNERS PERMIT E 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT-THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SV _
NEW HOUSE SEWER
SIGNED THIS DAY OF � 11Y�
OWNER -OR CONNECT ADDITIONAL
OWNERS AGENT I BUILDING OR WORK
SEPTIC TANK, SEEP, PITS)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY RDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR -
PLUMBING AND SEWS S. SEWAGE DISPOSAL SYSTEM .
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUI ED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR T AT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED gE5 TIAL PROPERTY. CKFIL
BAL SEPTIC TANKS❑-��J,
S "FILT(B) ❑ CESSPOOLS
SIGNATUR
OF PERMIT
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION -
BY . o3 3B4 7S SEP 26 4 4.50 In
DEPUTY DEPUTY
By BYv
® DEPUTY DEPUTY