HomeMy Public PortalAbout5227 DEGAS AVE_Sewer__ CEf10R 3-E4 8602- APPLICATION FOR PERMIT
CE �f
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION BU ILDINc r -P-
IOHN A. LAMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN. Supt of Building 4
LOCALITY 1
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
EGAL
DESCRIPTION LOT NO. OWNER
J G MAIL
BLOCK TRACT !R_-I': ADDRESS
NO. OF BLDGS. (�I
SIZE OF LOT NOW ON LOT 11 CITY �• ` TEL. NO,
USE OF
BU ILpINGS DISTRICT NO. GROUP MAP PR ESSEO BY
�
BK PG
CONTRACTOR ��'
ADDRESS CONNECTION DATA
E NO. STATION DEPTH
CITY
I -a-!94
. S ATE MANHOLE REFERENCE �J /�}
REGISTRATION NO. ODNTY LOWER
N. ESCRIPTION OF WORK FE TYPE OF CONNECTION LENGTHFROM
USE SEWER CONNECTING TO Y. CURB P:LC M.L.TO 1.
UBL DIC SEWER 35.00
P.C.NO. }
SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. JOB NO. d
PITS ANO/OR pRAINFIELD � SIO.00 O
NO U SE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, V
PRIVATE DISPOSAL SYSTEM @ 33.00
CONNECT ADDITIONAL BLDG,Ofl AFFIDAVIT .[IV[R [AS[M[MT RECORD.INSTR,NO, DATE O
WORKTO HOUSE SEWER a S3.00
OVERFLOW SEEPAGE PIT.GRAINFIELD ~
LXTN..CESSPOOL.DRYWELL.MANHOLE@ 55.00 w
ALTER.REPAIR OR ABANUUN HOUSE HWY.OR ST.WIDENING a
SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT N
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT S z 00 CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIN GISTIG OWELLING
TO THE PUBLIC SEW // APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS Y OF 196.,`` (y
OWNER ORRJ NEW HOUSE SE
OWNERS AGENT [. ���/� CONNECTADDIT IONAL I
ADDRESS Y[f/I��� BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
IH
ACKNOWLEDGE THAT 1 HAVE HEAD THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR A LTER.REPAIR,SEWER OR
LICENSED AS REOUIREO BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO OISCONN ECT PLUG ANO
RESIDE IN, THE ABOVE DESCRIBED RES TIA PROPERTY. ABANDON ROUSE SEW ER
SIGNATURE 1� BACKFILL SEPTIC TANK$ ElOF PERMITTEE
_ SEEP.PIT(S) ❑ CESSPOOLS ❑
I I
ALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.0, CASH
[ICo 1 6 9 9 E MIRY 17 1 0 D 7.0 0"