HomeMy Public PortalAbout5306 DEGAS AVE_Sewer__ 76A642 -61D APPLICATION FOR PERMIT
CESOB
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engg�� ear ADDRESS
WILLIAM A. JENSEN, Sup'1 of clodinq LOCALITY -l7
NEAREST
FOR APPLICANT TO FII L IN c Boss sr. Aa 0 s
LEGAL
DESCRIPTION LOT NO. '� OWNER
MAIL
BLOCK TRACT n•� ADDRESS c ! kis OL 6. , L
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY ,' -� TEL. NO
USE OF
BUILDINGS DISTRICT NO. GROUP-. MAP PROCESS BY
CONTRACTOR X BK P6
ADDRESS 2 6 CONNECTIO DATA
CITY 1• TEL.NO. STATION DEPTH
REGISTRATION NO. L /3 <e-— H COUNTY MANHOLE REFERENCE ; L UPP '�
NO. I DESCRIPTION OF WURK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM O L
PITS AND/OR DRAINFIELD @ C
$3.00 Y. URB P.L N.L.TO P.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ 52.00 d
HOUSE SEWER CONNECTING TO P.C.NO. //..
PRIVATE DISPOSA L SYSTEM @51.00 CO.INP. NO. ✓ /J QV
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER III= TRUNK PERMIT N0. ROAD PERMIT N0.
@
SEWER OR DIISPOSAL SYSTEM MOUSE @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL 1
WASTE APPROVAL CL
����rrwr.r�c.n� CHARGES Z
owNEnr$ Pmw $ Q 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR To CONNECT THE ABOVE DESCRIBJ:D EXISTING DWELLING [AND/OR
APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.n C// �^J
SIGNED THIS�DAY.O� r✓ t91-
OUSE SEWER r t I� ?1•A.. )
OWNER OR f I ECT ADDITIONAL '
OWNERS AGENT fit/ ING OR WORK
ADDRESSC TANK.SEEP.PIT(S)
R DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONAND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLYOOL ❑ DRYWELLWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,REPAIR,SEWER OR
PLUMBING AND SEWERS. GE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT�1 AM PROPERLY REGISTERED.AND/ORNNECT PLUG AND
LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OFDON HOUSE SEWER
CALIFORNIA OR THAT A THE LEGAL OWNER 0 THE ABOVE
DESCRIBED RESIDENT] PR PERTY. ILL SEPTIC TANKS ❑ Cl
SIGNATURE , // PITfS ❑ CESSPOOLS
OF PERMITTE C•�
/1jAL M.
0. C ROBERT A. WOOD
CK//J N.o. wH SUPERVISING MECHANICAL ENGINEER
�f4! 7 1 7 1- JAN 17 i G D .5 .0 0 n