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Home My Public Portal About5220 DEGAS AVE_Sewer__ cE80B APPLICATION FOR PERMIT CE8D �J COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION eUIL0ING JOHN A. LAMBIE. County Engineer ADDREBB �� Z[J ' L t WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. ' 7 LEGAL J] DESCRIPTION LOT NO. L/ OWNER MAIL BLOCK TRACT ADDRESS NO. OP: BL- S. C.. SIZE OF LOT NOW ON LOT CITY 7z TEL. NO. USE OF BUILDINGS DISTRICT NO, GROVP MAP PROCESSED BY BK PG CONTRACTOR ADDRESSCONNECTION DATA CITY 5 i ' STATION DEPTH/) q AT MANHOLE REFERENCE (i/� REGISTRATION NO. © /— COUNTY 1G G LOWER NO. DESCRIPTION OF WORK F TYPE OF CONNECTION LENGTH FROM 2e- 'Z7 HOUSE SEWER CONNECTING TO Y, CURB P.L M.L.TO P.L. PUBLIC SEWER 55.00 SEPTIC TANK,SEEPAGE PIT OR P.C,NO, N O PITS ANO/OR DRAINFIELD 510.00 CO.IMP. NO. JOB NO. - NOUBE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM 33.00 CONNECTADDITIONAL BLDG.OR AFFIDAVIT I WAIVIq .SL.AeT RECORpINBTR.NO. DATE WORK TO HOUSESEWER S3uo O OVERFLOW SEEPAGE PIT,DRAINFIELD V E%TN.OESSPOOL,DRYWELL,MANHOLE SS,00 Sy ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING N BEWER OR DISPOSAL SYSTEM S.O. STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S z o0 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON; REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THEPUBLIC BEW APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS Y OF 19 p�, OWNER OR NEW HOUSE SEW ER nom,/ OWNERS AGENT 46' CONNECT ADDITIONAL BUILDING OR WORK ADDRESS— SEPTIC TANK.SEEP,FIELD TIS) HEREBY ACKNOWLEDGE AAE THAT HAVE REAP THIS APPLICATION pryp/OR DRAINFIELD ANO BALL THAT THE ABOVE IB CORRECT AND AGREE E COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRV WELL ❑ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN. TH ABO O CRIBED R IDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERM ITT BEEP,PIT IBI ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD c M.o, CASH SUPERVISING MECHANICAL ENGINEER _.. I JILO 1 7 0 7- MAY 17 1 0 T 7.00-- N