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HomeMy Public PortalAbout5307 DEGAS AVE_Sewer__ -61 7BA642D APPLICATION FOR PERMIT �J1 II ]6A 64211 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 'uI DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING 347 6 JOHN A, LAMBIE, County Enginnnr ADDRESS WILLIAM A. JENSEN. SuP't of'Buildin4_ LOCALITY P( %7 Y. NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. _OWNER BLOCK TRACT ^ MAIL C 2 L ADDRESSL./'1 . L NO.OF BLDGS. � SIZE OF LOT NOW ON LOT. CITY PC C.i ` TEL. NO 7 USE OF BUILDINGS DISTRICT NO. GR O YAP PROCES BY l0 �BK� PG CONTRACTOR I/ ai IwG ADDRESS O z CONNECTI DATA CITY;/ GOU/ry L TEL.NO. _ O-2 L/ STATION © DEPTH REGISTRATION NO. G �.— 8 STATE MANHOLE REFERENCE ' I J COUNTY NO. I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ S3.00 C) SEPTIC TANK,SEEPAGE PIT OR TYPE OF CO CU l LENGTH FROM PITS AND/OR DRAINFIELD @ S3.00 T. CURB P.L .TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD - > EXTN..CESSPOOL.DRYWELL @ $2.00 G- HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. P,IGB-NB;� ...7 J U CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER 9 SI.00 TRUNK PERMIT NO. ROAD PERMIT N0. ALTER RE EER'ON DASPOSlIL SYSTEN HOUSE@ $1.00 STATE ENCROACHMENT O 'PERMIT NO. V INDUSTRIAL w 1 WASTE APPROVAL N �frwrcn CHARGES ? OWNERS I PERMIT $ 2100 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE Q REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAIS DATE INSPECTORIS SIGNATURE/ TO THE PUBLIC SEWER.n�J / MIA SIGNED THIS 2—DAY OF A 19�Z NEW HOUSE SEWER / IA OWNER OR [t RGd CONNECT ADDITIONAL OWNERS AGENT r BUILDING OR'WORK I ADDRESS SEPTIC TANK,SEEP.PIT(S) AHD/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRTWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR PLUMBING AND SEWERS. - - - - -SEWAGE DISPOSAL SYSTE 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFCALIFOABANDON HOUSE SEWER DESCRIBED ES THAT 1 THE LEGAL OF THE ABOVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDENTIA PR PERTY. SIGNATURESEEP.PIT(S) ❑ CESSPOOLS OF PERMITTE VCK. ALIDATION ROBERT A. WOOD M.o, cAatl SUPERVISING MECHANICAL]ENGINEER UP 7 1 0.3 JAII 1 7 10 0 5.0 0