HomeMy Public PortalAbout9037 CALLITA ST_Sewer__ CE6D35-55
J SA 6420 APPLICATION FOR PERMIT CJ.'�
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER WAGE SEWER—SEDISPOSAL lul
BUILDING AND SAFETY DIVISION BUILDING
JouN A. L.A.NiHu;. COeno. Engineer ADDRESS 9037 C l.lita
COLENIAV W. JENKINS.5Up'L. o[Roildmg
wcauTY m _
NEAREST
FOR APPLICANT TO FILL IN °ROSS sT. $ —Blvd
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT / ADDRESS. "7 i
SIZE OF LOT , NOOF
ON LOT LOOTS CITY q~•c� g,7 NO. 287-3654
USE OF
BUILDINGS U Ain 1 DISTRICT NO, GROU Mqp PROCESSED BY
p- �I'/Jf( BK P//Gj�I'/}/ Q
CONTRACTOR J & D n-1'umbI coV �PV �_ V v
ADDRESS 414 O San a br; P1 TRS_ C NECTION DATA
CITY SanGabriel--TEL, NO. At. 70579 STATION DEPTH
LICENSE LICENSE UPPER
NO. q CLA55 MANHOLE REFERENCE —E
NO. D R PTION OF WORK FEE /
TYPE OF CONNECTION LENGTH FR
NOUS F. SEWER CONNECTING TO Y. CURB P.L. M.L TO P.
PUBLIC SEW EP 0 S i00 58bo—
P.C.NO. d
SEPTIC TANK-SEEPAGE PIT OR CO.IMP. NO. JOB NO. O
PITS ANO/OR DRAINFIELD 410.00
HOUSE 5EWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. u
PRIVATE DISPOSAL SYSTEM $ 3.00
11
CONNECT ADDITI00AL BLDG, OR AFFIDAVIT wuVLx ez[x[n RECORD. INSTR.NO. GATE O
WORK TO HOUSE SEWED _ $ 3.00
ATTRE A R OR ABANOBN HODSC V
SEWER OR DISPOSAL SYSTEM [ $ 3.00 W
ERTT HWY,OR ST,WIDENING 1
EXT I, CESSPOOL. MANHOLE ^ $ 5.00 h
STATE ENCROACH MENT Z
PERCOLATION TEST @ S 5.00 PERMIT NO.
INOU5TRIAL
WASTE APPROVAL
OWNERS PERMIT s z o0 CHARGES
AUTHORIZATION TOTAL FEE 1 7 00 CONNECTION CHARGE FEE
-I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EIIISTING DWELLING }Cx
TO THE PUBLIC SEWER. APPROVALS DATE INSPEC R' SIGNATURE
SIGNED THIS DAV F I I9
OWNEROR / NEW HOUSE SEWER 4
OWNERS AGENY
CONNECT ADDITIONAL
ADDRESS BUILOING OR WORK
SEPTIC TANK,SEEP,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION EID (S)
AND STATE THAT THE ABOVE IS CORRECT AN AGREE TO COMPLY AND/OR DRAINFILD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER, REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEW AGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO GISCONNECT PEUG AND
RE51 DE IN, THE ABOVE DESCRIBE ESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITT BAC KFIIL SEPTIC TANKS ❑ ( / j
-- SEEP.PIT 15 ESSPOOLS I • `�/ +.(e
VALIDATIO __
CK. M.O. CASH
LRL 0 5 9 1 3'�2 NOY 18 1 a D 7..00-
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