HomeMy Public PortalAbout9018 CALLITA ST_Sewer__ I
EE608 3-E4 APPLICATION FOR PERG11�
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL ILII
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION am LDlryc A
JOHN A. LAMBIE. County Engineer ADDREss
WILLIAM A. JENSEN. Sup't of Building
LOCALITY C
NEAREST
FOR APPLICANT TO FILL IN CRO55
LEGAL
DESCRIPTION LOTNO. 179
OWNER
MAIL
BLOCK TRACT Z ADDRESS
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS 1. A DISTRICT NO.1 GROUP MAP PP�ED BY
SK ^/ POPO-0 I
CONTRACTOR am
ADDRESS �p / CONNECTION DATA/
TY �/ TEL. ND. ��O STATION -p/ DEPTH, //T
IVVL//� PER
REGISTRATION `/` L�/ Z� COUATNE <TY MANHOLE REFERENCE
NONO.. GESCRI PT ON OF WORK FEE TYPE OF CONNECTION LENGT POM /
HOUSE SEWER CONNECTING TO a� Y. CURB P.
PUBLICSEWER @ moo s ��
SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. O JOB NO. d
PITS AND/OR DRAINFIELD 310.00 O
HOUSE SEWER CONNECTING TO THUNK PERMIT NO. ROAD PERMIT NO. U
PRIVATE DISPOSAL SYSTEM $3,00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT uvq u5[x[xi RECORD.I NSTR.NO, DATE
WORK TO HOUSE SEWE R $3.00 O
OVERFLOW SEEPAGE PIT,DRAINFIELD ~
EXTN„CE5SPOOL.DRYWELL,MANHOLES $5.00 W
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING CL
SEWER OR DISPOSAL SYSTEM Q 33.00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s z o0
AUTHORIZATION 70TAL FEE O CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEflE1N [ MED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT HE 4BOVE DES [BED E%ISTI[ DWELLING
TO THE PUBLIC E. ' / APPROVALS DATE IN PE OR'S SIGNATURE
SIGNED THIS DAA OF '�/ 1
OWNER OR NEW HOUSE SEWER V
OWNERSA
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
6TANK,SEEP.PIT(6)
1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION gND/OR GRAINFIELD
AND STATE THAT THE ABOVE I6 CORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR
LICENSE° AS flEOUIR BT LOS ANGLES COUNTY ANO 6TATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TMA 1 AM TH LEGAL OWNER 4N° INTEN° TO 0ISCONNECTPLUG AND
RE610E IN, THE AB °E6 BE IpEll OPERTY. ABANDON HOUSE SEWER
SIGNATURE (� DACKFILL SEPTIC TANKS ❑
OF PERMITTEE
6EEP.PITIS) [ICESSPOOLS C11 I
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
„ CK. M.0. CABH
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