HomeMy Public PortalAbout9019 CALLITA ST_Sewer__ <EBDB B.Bx APPLICATION FOR PERMIT
7GA842D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDREss
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN R.G.CsT
EGAL
DESCRIPTION ICT NO. OWNER
fff ^ MAIL
BLOCK TRACT �� � ADDRESS IV
NO. OF BLOCS. ' /� J
SIZE OF LOT NOW ON LOT CITY TEL. NO u
VSE OF BUILDINDISTRICT NO. GROUP BK MAP PGPROCESSED BY
G$
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CONTRACTOR_ C -N /oc� ,
ADDRESS CONNECTION DATA
CITY ��' N STATION ` DEPTH D
STATE 'e=(J LI< A 4 MANHOLE REFERENCE MJ O
LICENSE NO. CLASS
NO. .DESCRIPI ION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. _ CURB P.L. M.L.TO P.L. 3 a
PUBLIC SEWER a sR.00
SEPTIC TANK.SEEPAGE PIT OR P.C.N°. O
CO. IMP.NO. JOB NO.
PITS AND/OR GRAINFIELD � E10.00 U
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. K
PRIVATE DISPOSAL SYSTEM O
CONNECT ADDITIONAL SLOG,OR AFFIDAVIT AY [6a[ve RECORD.INSTR.NO, DATE F
WORK TO H OUSE SEWER E3.00 U
OVERFLOW SEEPAGE PIT.GRAINFIELD a
EXTN..CESSPOOL.DRYWELL.MANHOLE� 55.00
ALTER.REPAIR OR ABANDON MOUSE HWY.OR ST.WIDENING H
SEWER OR DISPOSAL SYSTEM E3.00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER'S pEAMTT $1 21 00 CHARGES
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INS CTOR'S BI NATURE
SIGNED THIS DAY OF 19_
OWNEROR NEW HOUSE SEWER
OWNERS AGENT_
CONNECT ADDITIONAL
ADDRESS - BUILDING OR WORN
SEPTIC TANK.SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AN./OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER.REFAI R,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
ULIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO ISCONNECT DPLUG ANO
RESIDE IN, THE AB VE OESCR BED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑,
OF PERMRTEE SEEP.PIT ISI ❑ CEBSPOO S q
VALIDATION JACK R. ALLEN
' J SUPERVISING MECHANICAL ENGINEER
K.
M.0. CASH
Lhl07 7 3 62 Aub' 2
/3/ 0 D 7.00-