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Home My Public Portal About9025 CALLITA ST_Sewer__ 2D 676A&4&E�663 12-96 APPLICATION FOR PERMIT � I� 8 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer - - - County of Los Angeles BUILDING` WM.J. FOX. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST \\ • {�f t CROSS ST. LEGAL � DESCRIPTION LOT NO. OWNER BLOCK TRACT Sr� AMA IDDRE NO. OF SLOGS. - y LA/./ SIZE OF LOT .,NOW ON LOT // ) CIT, TEL USEF `O _ NGS { j-- I G� LF9A:P^.�1 .AtHst�^' _ DISTRICT NO. GROUP MAP BK PG CONTRACTOR ADDRESSy / ` LV. �`�y 1/" / / ' ✓ CONNECTION DATA CITY A.4� �J TEL. NO� A.� !� V STATION ?51- 7� _` DEPTH l ATE MANHOLE REFERENCE. i REGISTRATION NO. vi >` - ❑ COUNTY UPPER -OWER YJ f TYPE OF CONNECTtHN'� LENGTH,, ON i No. DESCRIPTION OF WORK FEE Y. CURB ! P.L: M.L.TO P.L. a� i HOUSE SEWER CONNECTING TO PUBLIC SEWER © $ 3.50 /) 1 HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 �— CONNECT ADDITIONAL BLDG. OR _ WORK TO HOUSE SEWER 1.00 CO. IMP. N0. L ' JOB. N0. ALTER OR REPAIR EXISTING _ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DISAND/OR DISPOSCT AL ABANDON SEWER STATE ENCROACHMENT / SEPTIC DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR RYWELL GRAINFIELD 2.00 INDUSTRIAL / CESSPOOL- ORYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 __ CHARGES PERMIT CONNECTION CHARGE FEE / OWNERS /1 1 00 x AUTHORIZATION TOTAL FEE REIMBURI HAVE SEMENT FEE MED CON. TRACTORTHIS DATE TO CONNECT THEACTED ABOVEWITH DESC UBJ DHEREIN EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEW A �–)� EW HOUSE SEWER NNN:JJJ777000!lIMYL•!! SIGNED THIS DA O 19_ OWNER OR R CONNECT ADDITIONAL OWNERS NT BUILDING OR WORK ADDREB 9. A . .t /. SEPTIC TANK. SEEP, PIT(S) AND/OR GRAINFIELD 1 HER Y AeKN WLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STAT[THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL YEW TY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I A THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT A P PERTY./^I BACKFILL SEPTIC TANKS❑ SEEP. PIT(S) ❑ CESSPOOLSGJ �,7^ ] 1 SIGNATURE . 9 OF PERMIT E ' WILLIAM J. FOX, COUNTY ENGINEER VALIDATION by BY- '1CO7 T 9 7`� SEP 1 4/^�/ 4_ .50 10 . DEPUTY DEPUTY -BY BT ® DEPUTY DEPUTY