HomeMy Public PortalAbout5208 DALEVIEW AVE_Sewer__ ]6A 642D-CE8
08-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER r
BUILDING AND SAFETY DIVISION BUILDING �d 1CL,lG L�
.DRESS
LOCALITY
FOR APPLICANT TO FILL IN CROSSNEAREST - /^
NEARS ST.
M
DESCRIPTION LOT NO, ffff OWNER • ! /
/� O TRACT l yd 120 MAIL j'_71,0
BLOCK ADDRESS
NO. OF BLDGd. ,y / V� 7SIZE OF LOT NOW ON LOT CITY [ y ` T/ T.L. NO.
USE OF
BUILDING$ OISTgICT NO. GROUP MAP P CESSED By
CONTRACTOR
ADDRESS p - )�j� CONNECTION. DAP
CITY 10:47J'7-Gdp1 TEL. NO, 7,>' L3. STATION DEPTH
STATE `I LIC MANHOLE REFERENCE UPPER
LICENSE NO. (Q�i CLASS LOWER
NO. DESCRIPTION OF WORK FEE TYPEOF ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBL IC SEWER $7,00 OD
SEPTIC TANK,SEEPAGE PIT OR - P.C.NO
PITS AND/OR DRAINFIELD ® SIOOO CO. P. NO.
® HOUSE SEWER CONNECTING TO TRUNK PERMIT ROAD PERMIT NO, d
PRIVATE DISPOSAL SYSTEM 53.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIV[II ASENI RECORD. INSTR.NO. DATE v
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT.GRAINFIELD yr
E.TN..CESSPOOL,ORYWELL. G $5.00 HWY.OR ST,WIDENING O
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT W
MANHOLE $7.00 PERMIT NO. CL INDUSTRIAL GO
WASTE APPROVAL Z
OWNERS PERMIT $ s oo
AUTHORIZATION TOTAL FEE loo ONN ECTION CHANGE FEE CHARGES
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED BCON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWS yv APPROVALS DATE INSPECTOR'5 SIGNATURE
SIGNED THIS DAY OF A�7 IL, 1971
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
_ CONNECT ADDITIONAL
w DORE55r if ���/� BUILDING OR WORK �7- V A .r)�
SEPTIC TANK.SEEP,PITS)
HEREBYACKNOWLEDGETHAT
TIT BO THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE PIMA IS CORRECT AND AGREE E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE O SCRI D RESIDENTIAL PROPT. pBgN.ONHOUSE BE WE
SIGNATURE
OF PERMRTEE BACKFILL SEPTIC TANK$ ❑
SEEP.PIT I51 POOLS ❑
VALIDATION CK` m,O CASH
j ,if_ 4 0 0 8?-1 DEC 6.0 0. R