HomeMy Public PortalAbout5302 DEGAS AVE_Sewer__ CE808 3BA64 D
7APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING (^�
JOHN A, LAMBIE. County Engineer ADDRESS c�
WILLIAM A. JENSEN, SuP't of Building LOCALITY FrN _r
NEAREST
FOR APPLICANT TO/ FELL IN caoss sr.
LEGAL '1 OWNER ( l
DESCRIPTION L07 N0. I�
AIL
BLOCK TRACT ADDRESS
NO.OF BLDGS. /
SIZE OF LOT NOW ON LOT CITY PLc ` .St TEL. NO 4'
USE OF
BUILDINGS DISTRICT N0. GRO YAP (� PROQESSEO BY
S BK — P6/� L
CONTRACTOR L t QA`j _0. U11 L
ADDRESS �) CONNECTION DATA
CITY TEL.NO2 C/ STATION DEPTH
REGISTRATION NO. G ^ ` —L STATE COUNTY MANHOLE REFERENCE IJPPER,NO. I DESCRIPTION OF wFEE
HOUSE
EWE SEWER (9
TOPUBL@ E3.00 QO
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FftOY
PITS AND/OR DRAINFI ELD 55.00 T. CURB P.L. Y.L.TOP.L.
OVERFLOW SEEPAGEPIT. DRAIN FIELD \ }
EXTN..CESSPOOL.DRYWE LL @ 52.00 IL
HOUSE SEWER CONNECTING TO /J U
PRIVATE DISPOSAL SYSTEM @ E1.00 CO.IMP. N0. PFOB-NSA O
CONNECT ADDITIONAL BLDG.OR J() R'EIMBURSEMENT
RUNK PERMIT N0. ROAD PERMIT NO. tY
WORK TO HOUSE SEWER EI.00
SEWER REPAIR
R DISPOSAL SYSTEM HOUSE @ $1.00TATE ENCROACHMENT O
E RMIT NO. U
DUSTRIAL - CL
CL
ASTE APPROVAL N
e CHARGES z
OWNER'S PERMIT s 2 ONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE S FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN.NAMED CON.
TRACTOR TO CONNECT THE ABOVE DEBEp EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNAT ?E
TO THE PUBLICSEWER.
SIGNED THIS DAY OF— 9�I
NEW HOUSE SEWER I l�Lc2
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT { F'*� BUILDINGORWORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT F HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLYCESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER.REPAIR.SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED ANDDISCONNECT PLUG AND
LICENSED AS REQUIRED_ C LOS ANGELES COUNTY ND $TATE OFpBANOON HOUSE SEWER
CALIFORNIA OR THAT M THE LEGAL OW ER F THE ABOVE
DESCRIBED RESIDENTIAL P QPERTY. _ BACKFILL SEPTIC TANKS ❑
SIGNATURE �`� SEEP.PIT(5) ❑ CESSPOOLS
OF PERMITTEEi!
ALMATION ROBERT A. WOOD
CX.
Ill.0. CASH .SUPERVISING MECHANICAL ENGINEER
CF o 7 0 JAN 17 1 0 0 5.0 0 kD