HomeMy Public PortalAbout9024 CALLITA ST_Sewer__ i
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C14508 II-99 APPLICATION FOR PERMIT.
COUNTY OF LOS ANGELES SEWER,--SEWAGE. DISP.-OSAL.
' DEPARTMENT OF COUNTYENGINEER - -
BUILDING AND SAFETY DIVISION BUILDING
TORN A. LAMBIE, County. Engineer ADDRESS Q
CASSATT D. GRIFFIN, Supt of Building LOCALITY `�T Tf
FOR APPLICANT TO FILL IN "O"'T. &ka ck :vc:
LEGAL .>-• �'
DESCRIPTION LOT NO. OWNER
BLOCK TRACT j2jS 7— - _ - MAIL
ADDRESS O-1 s2.. r- _' .p.`.•� IVNOF BLOB . '
SIZE OF LOT I NOWOON LOTS y - ,T Tl d .I iiTi.
'CITY ) .TEL.N0:
USE OF _ A
DISTRICT 0. GROUP MAP
Y ��
CONTRACTOR -71
BK /PAYC/
ADDRESS I CONNECTION DATA V
CITY r TEL. NO. _ STATION DEPTH
❑
STATE MANHOLE REFERENCE /
REGISTRATION NO. COUNTY LOWE
NO: DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3"%,-aUr�D - "' '
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTIOy�e LENGTH FROM [7
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L.
M.L.TO P.L. oC
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ '$2.00
HOUSE SEWER CONNECTING TO P. C,N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR -
WORK TO HOUSE SEWER @ $1.00 ' TRUNK PERMIT NO. ROAD PERMIT NO. _
ALTER,REPAIR OR ABANDON HOUSE ._
SEWER OR DISPOSAL SYSTEM @ .$1.00 STATE ENCROACHMENT
- PERMIT N0. \
INDUSTRIAL
WASTE APPROVAL �...!
.CHARGES"\
OWNERS PERMIT $ OO CONNECTIONS CHARGE'FEE -
AUTHORIZATION "TOTAL FEE - - /'J
REIMBURSEMENT FEE
1 HAVEATTHIS-DATE A-CONTRACT WITH THE HEREIN-NAMED CON. - —�—
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC _SE'WEgpRg _ __ � p _ _ _ _ _ 2_t'7D _F9 / ~
__
SIGNED THIS
�DAY OF' --I 9—L NEW HOUSE SEWER "ZJ •7 l h.011,C(/
OWNEROR - - - - +- - - `- CONNECT
QI ADDITIONAL AL
OWNERS AGENT bBUILDING WORK
ADDRESS- OO- T�- --- --- -
-.SEPTICTANK,.SEEP, PIT(S)-- - - - - _
~+ '"AND/OR'DRAINFIELD'
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION C 'L.- V. 1 .4
AND STATE THAT THE ABOVE IS CORRECT-AND AGREE TO,COMP.LY- ..CESSP006❑ DRYWELL-O- - -- ---^ ----- =--.-�^+- -
WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
"PLUMBING AND SEWERS. -.ALTER,SEWAGREPAIR,
EWER OR
1 HEREBY-CERTIFY-THAT-1 AM' PROPER LY-REGISTERED AND/ORS' -- -
EM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I RO THE LEGAL_ NER,�OF-THE..ABOVE_ ABANDON HOUSE SEWER
DESCRIBED RESI DENA PROPERTY BACKFILL SEPTIC TANKS ❑
C } iL / . SEEP. PIT(S) CESSPOOLS
SIGNATURE �t,.�'!�.c� - _ -- _
OF'PERMITTE
'-VALIDATION.-- _ _ _._ ..ROBERTA7WOOD_ -^---T--
ca. SUPERVISING MECHANICAL ENGINEER -
- - - - - - - - - 1-9_3 1 '; ,JAN191-p-A -• -
' 5:00.. .. ---