HomeMy Public PortalAbout9032 CALLITA ST_Sewer__ O
5&E-683 1254 APPLICATION: FOR PERM
'6 6 �8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer ('� (7 \
County of Lou Angeles BUILDING `•S \ A�\�•A�
SSA J. FOX, COUNTY ENGINEER ADDRES
CASBATT D. GRIFFIN.Bw•i of BuuDINc . LOCALITY
FOR APPLICANT TO FILL IN NEAREST f
CROSS ST.
LEGAL C
DESCRIPTION LOT N0. -5`7 OWNER �h rt�
BLOCK TRACT L 1 MAIL
DDRESS \M(L
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF {
BUILDINGS ` DISTRICT NO. GROUP MAP
CONTRACTOR CALIF.SEWER CONST.CO. � l B; =G
ADDRESS 131T COLEGROVE AVE. CONNECTION DATA
CITY' MONTEBELLO TEL. No.P.A. 1-5048 STATION 4(- 5,V DEPTH
I w n ❑ STATE NANHOLE REFERENCE ��
REGISTRATION NO. 148659 (STATE) ❑ COUNTY UPPER 4l�� LOWER
TYPE OF CONNECTION, LENG Y. FROM
NO. DESCRIPTION OF WORK FEE Y. CURB / P.L: M.L. TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q S 3.50 =%,
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG. OR CO. INP. NO. > ` JOB. N0.
_ WORK TO HOUSE SEWER I.00
ALTER DISCONNECT REPAIR EXISTING ——
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ANDRDISPO A A SYSTEM J SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL• ORYWELRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGE
CONNECTION CHARGE FEE
OWNER'S PERMIT E 1 00
AUTHORIZATION TOTAL FEE 3 REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS D TE IN TOR'5 SIGNA;jURE
TO THE PUBLIC SEW,
r,- NEW HOUSE SEWER Sal SJ
SIGNED THIS DAY OF 79s�
OWNER OR CONNECT ADDITIONAL /
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY'REGISTERED AND/OR ECT PLUG AND
D
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
HOUSE SEW .n
CALIFORNIA OR� THAT I AM THE LE L OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPE Y. BACKFILL SEPTIC TANKS❑♦♦
SEEP. PIT(S).❑ CESSPOOLy d
SIGNATURE
OF.PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
AC0 7 3 5 u� AUG 31 4 4.5 0
'BT BY ._. _
DEPUTY DEPUTY
I.BY BY
'� DEPUTY DEPUTY