HomeMy Public PortalAbout5312 DEGAS AVE_Sewer__ 76AB42DD .
APPLICATION FOR PERMIT ' '
]6A 84 �
COUNTY OF LOS ANGELES SEWER-SEWAGE -DISPOSAL I'�I
DEPARTMENT .OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING •n
G
TORN A, LAMBIE, County Eaq�neer ADDRESS
/'
WILLIAM A. IENSEN, Sup'1 of Building LOCALITY ( (/ v-
NEAREST
FOR APPLICANT TO FELL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT n MAIL _
>� 2 ADDRESS 17 L NO.OF BUDG
O'
SIZE OF LOT NOW ON LOTS 2 CITY rl .TEL. NO - 4_7K2?-1D '
USE OF
.BUILDINGS DISTRICT NO.15ROUP MAP PROCESSD BY
CONTRACTOR ,� BE PQ
CON �
J
ADDRESS r CONNECT[ DATA
CITY^ I TEL.NO. (J—z L� STATION DEPTH
0 7
REGISTRATION NO. S �. L B WUNTYMANXOLE REFERENCE
NO. I DESCRIPTION OF WgR FEE
HOUSE SEWER CONNECTING TO �0
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR - TYPE OF CONNECTION LENGTH FROM '7
PITS AND/OR DRAINFIELD @ SS.00 T• CURB .P.L. M.L.TOP.L. a"C
OVERFLOW SEEPAGE PIT.DRAINFIELD }
EXTN..CESSPOOL.DRYWFII` @ $2.00 _ CL
PRIVATE DISPOSAL SYSTEM TO @ t,no CO.IMP. NO. P.BHffi 0 J O
U
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N0. 0=
ALTER,REPAIR OR ABANDON HOUSE STATEENCROACHMENT O
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. U
INDUSTRIAL LU
O_
WASTE APPROVAL N
CHARGES ?
ON/NERls PERM $ 2 OO CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE I REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN.NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIS EXISTING DWELLING a APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS_X DAY NEW HOUSE SEWER 9//, r ><.�`-moi
OWNER OR A CON NECT ADDITIONAL I 1
OWNERS AGENT �t BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVEE IC CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES
S AND STATE LAWS REGULATING SEWAGE DISPOSAL SYSTEM-THAT
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY 'THAT I AN PROPERLY REGISTERED AND/OR' DISCONNECT'PLUG AND
LICENSED
REOUIREO LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT M THE LEGAL OWNER THE ABOVE
DESCRIBED RESIDENT L P OPERTT. 'BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(,)
IT(S) ❑ CESSPOOLS
OF PERMITTEE
VALIDATION ROBERT A. WOOD
CK. Y.o._ CUN SUPERVISING MECHANICAL ENGINEER
L
�7 i za JAN17 1 0 D 5.00