HomeMy Public PortalAbout5210 DALEVIEW AVE_Sewer__ 24650-INSERTS
DE.a°aar APPLICATION FOR PERMIT y
80.69 SEWER-SEWAGE DISPOSAL, 1
! COUNTY OF LOS ANGELES "
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVA ..E'S
ISION G .T -
JOHN A. LAMBIE, County Evgweer O �S�rrw///C l0 )
WILLIAM A. JENSEN. Supt oI Building LOCALITY
FOR APPLICANT TO FILL IN
CROSS ST. �K
' LEGAL OWNER
DESCRIPTION LOT N0.
`. BLOCK TRACTZj�oa e_? MAIL
ADDRESS
c DG
SIZE OF LOT ' K 1O ' NOW O[NOO LOTS 'CIT TEL. NO. -D a/
OF
BUELDINIS - ./ DIS CT NO.I GROUEA
_ BK MAP PG PROCESSED By L
CONTRACTOR .f.�+�G/rJ �J�� � O -
ADDRESS rte/ O ^ CONNECTION DATA
S� � �7 �ifi'-C1A.i7 � .
CITY �o � TEL.NO. lJ'�,� y-Q ya 'STATION DEPTH
�`- ❑ STATE MANHOLE REFERENCE
N ?
REGISTRATION 0. ❑ COUNTY OWER
NO. DESCRIPTION OF WORK FEE 9 "
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ 83.00 J V v TYPE OF CONNECT' LENGTH FROM
PETS'AND/OR DRAC TANK. ENFIELDT OR @ $3.00 Y. CURB P.L. M.L.TO P.L. J�
OVERFLOW SEEPAGE PIT. DRAINNELD
EXTN.. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO 1-5 P.C.NO-
PRIVATE DISPOSAL SYSTEM @ $1.00 CO, IMP. NO. JOB N0, h
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. U
@
WORK TO HOUSE SEWER $1.00
ALTER. REPAIR OR ABANDON HOUSE STATE ENCROACHMENT W
-SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. {OI..
INDUSTRIAL U
WASTE APPROVAL W
CHARGES
OWNER'S PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 1 -'5— 00 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGN :.URE
TO THE PUBLIC SEWER. C
SIGNED THIS DAY OF-19_ NEW HOUSESEWER 7/-/ % _^ - f- -✓F/'
OWNER OR
CONNECT ADDITIONAL
OWNER$AGENT .BUILDING OR-WORK
-
z - -
ADDRESS SEPTIC TANK,SEEP,PIT(S)
AND/Oft DRAINFIELD
1 .HEREBY-ACKNOWLEDGE-THAT 1 HAVE HEAD THIS APPLICATION- - - - - - -- - -- - - - -- -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL D DRYWELL.❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - ALTER,ftEPA1R,.5EWER OR _
PLUMBING AND SEWERS. SEWAGE DISPOSAL EWERO SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY. AND STATE OF. ABANDON CT PLUG
HOUSE "
CALIFORNIA OR THAT IAM THE LEGAL DARER OF THE ABOVE
DESCRIBED RESIDENT L PRO�P iRT�Y. BACKFILL SEPTIC TANKS 0
SIGNATURE � SEEP..PIT(S) [I.D CESSPOOLS _
OF PERMITTE �/vmi-+'�t� ���h�
-
®r VALIDATION t \ROBERT A. WOOD ,
CK. M.0. GSH SUPERVISING MECHANICALER
ul)7 5 0 1 1',it'!2 -2) 1. D 5 .00 ;^