HomeMy Public PortalAbout5102 DALEVIEW AVE_Sewer__ S E.03(Y-IISr APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer -
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS l
"® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ✓
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FOR APPLICANT TO FILL IN NLAsas si.
LEGAL
DESCRIPTION LOT NO. OWMAINER
BLOCK TRACT / O`�O MAIL
ADDRESS
NO OF
SIZE OF LOT f, X NOW ON LOTS Z CITY TEL, NO.
USE OF
BUILDINGSDISTRICT NO. GROUP. MAP
BK PG
CONTRACTOR -
ADDaEss -CONNECTION DATA
CITY TEL. N0. O STATION DEPTH
/I, E-W .TE MANHOLE REFERENCE UPPER
REGISTRATION NO. J/ IY i.J.K) ❑ COUNTY ��� LOWER
NO. DESCRIPTION OF WORK FEE. zz; O^
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
_ PUBLIC SEWER Q s 3.50 Y' CURB P.I. M.L. TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT HOUSES W BLDG. OR -.dO 6 CO. IMP. NO. JOB NO.
,CONN.VVORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD ERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0.
SEPTIC TANK. SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL %
CESSPOOL-DRYWELL WASTE APPROVAL'
SPECIAL CONDITIONS ONLY 2.00 CH GES
OWNER'S
PERMIT S 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE !L_ FEE
' I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE. PUBLIC SEWER ,
SIGNED THIS DAY OF 13_ NEW HOUSE SEWER
CONNECT ADR NAL
OWNER OR BUILDING WORK
OWNERS AGENT
SEPTIC TANK, P, PIT(S)
ADDRESS AND/OR DRgINFIEF1ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL El ORYW ELL.❑.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND 'STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTYBACKFILL SEPTIC TANKS❑
' SEEP. PITS [ICESSPOOLS[ISIOF PEGNATURE ii
R M ITTEE
WILLIAM JJ FOX,COUNTY ENGINEER- VALIDATION R.A. WOOD. CHIEF PLBG• INSPECTOR
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