HomeMy Public PortalAbout5230 DALEVIEW AVE_Sewer__ JOAe°'B" APPLICATION FOR PERMIT
CEBBB B:BY
COUNTY of LOS ANGELES SEWER—SEWAGE DISPOSAL -�
-DEPARTMENT OF COUNTY ENGINEER, '
BUILDING AND SAFETY DIVISION.. BUILDING
JGHN A,-LAMBIE. County En neer ADDRESS`. �_Aa �� A� '•
CASSATI D. GBI" $up'Y of SuildinQ LOCALITY
I NEAREST
'FOR APPLICANT TO FILL IN
.CROSS ST. ILS
LEGAL - - 15-..� L OWNER , - •-
DESCRIPTION. LOT N0.
BLOCK: TRACT MAIL -
�'9 U - oo (/ -
ADDRESS' ��f1
NO.OFBLDGS. - '
SIZE OF LOT NOWON LOT CITY TEL. NO:
BUILDINGS BK PG- _ DISTRICT NO. 'GROUP -MAP - I PROCESSED"BY i
Q-
CONTRACTOR r / 4V
ADDRESS -. - NNECTIION DATA '
'TEL.NO.� - •�Lam"-' STATIO�fi' DtPTH
TATE MANHOLE.REFERENCE PPER
REGISTRATION MO:��.,�c}7�. COUNTY• -L IDWER .
NO. DESCRIPTION OF WORK ' FEE
HOUSE SEWER'.CONNECTING TO J
PUBLIC SEWER @ $3.00 OF,CON NEC 1 _ ENGTH FRO _
SEPTIC.TANK.SEEPAGEPIT OR Y. CURB. - P.L. M.L:TOP
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE.PIT,DRAINFIELD -
EXTN..CESSPOOL..DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P .NO.
PRIVATE DISPOSAL SYSTEM- @ $1.00 Co...IMP. N0. OB'N0.
.CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. OAD PERMIT'N 0.
T ,
WORK TO HOUSE.SEWER @ $I.00
ALTER,R DISPOSAL LSYSTEM HOUSE @ $I 00 .� STATE ENCROACHME _
PERMIT NO.
INDUSTRIAL
WASTE APPR L
' - CHARGES
OWNER'S PERMIT. $ _ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I. TOTAL FEE REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACTCON-
TRACTOR TO CION N ECT THE ABOVE EISCRIBEDTHE'EXIISTINGHEREINAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE.
TO•THE PUBLIC SEWER.
SIGNED THIS DAY OF I9_ NEW HOUSESEWER
OWNER OR
CONNECT ADDITIONAL -
OWNERSAGENT '- ")�CLU"T BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT-1-HAVE READ THIS*APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE •LAWS REGULATING ALTER,REPAIR.SEWER OR -
PLUMBING AND SEWERS. SEWAGE DISPOSAL-SYSTEM
1 •HEREBY CERTIFY,-THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED-AS REQUIRED,:BY'LOS ANGELES COUNTY AND STATE OF DISCON ECT PLUGAHOUSE D
CALIFORNIA OR._THAT 1 .AM THE LEGAL OWNER OF THE-ABOVE
DESCRIBED RESIDENVAL PROPERTY. BACKFILL CESSPOOLS ❑
SEPTIC TANKS E
SEEP.PIT(S) ❑
SIGNATURE -
'OF.PERMITT - � _
®.
VALIDATION .ROBERT A. WOOD
GASH.' SUPERVISINGMECHANICAL ENGINEER: -
jIuO
6.:8 1 6 o rEE3'.?3 1 G.q ` , 3 •0<0