HomeMy Public PortalAbout5222,5220 DALEVIEW AVE_Sewer__' - 1
" APPLICATION FOR PERMIT 1
e (DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT OF BOU.OING LOCALITY T�
FOR APPLICANT TO FILL IN CROSSS ST.
LEGAL 41
4 OWNER
DESCRIPTION LOT NO. J
MAIL
BLOCK TRACT D AppRE85
J 10 OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT N0. GROUP ~MAP
BUILDINGS 71
BK PG
CONTRACTOR
ADDRESS 7j CONNECTION DATA
of
STATION DEPTH
-CITY TEL. NO.047, ,.,/ MANHOLE REFERENCE UPPER
— t y)•a7pTE LOWER
REGISTRATION NO. ❑ COUNTY GO 7
NO. DESCRIPTION K FEEG>'-4 1
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50
Y. CURB P.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P.C' N0.
EXTN..CESSPOOL,DRYWELL,M AN HOLE (a- $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM CRS $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR _ STATE ENCROACHMENT
WORK TO HOUSE SEWER La' $I.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM n $1DO INDUSTRIAL
_ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g t 00
AUTHORIZATION TOTAL IEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT 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 IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRE❑ BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I qqM THE LEGAL OWNER OF T OV -
p' RUBE RES TI I(OPERT '� BACKFILL SEPTIC TANKS❑
S VYI� ' SEEP.PIT(51 Ll CESSPOOLS❑
OF ERMITTE
JOHN A. LAM IE. COUNTY ENGINEER VALIDATIon ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CASH
IACO2439 °° MAR 28 4 A 3.00