HomeMy Public PortalAbout5313 DEGAS AVE_Sewer__ 2
CESOB 3-61
76A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A, LAMBIE, Covvty EnIgn!
ADDRESS
WILLIAM A. IENSEN. Supt oI In!
LOCALITY MAC C/7K
NEAREST
FOR APPLICANT TO FIIJ IN cn6Ss sr. W'a'Nt
LEGAL
DESCRIPTION LOT NO. OWNER fl, �(IlgoeK
BLOCK TRACT 2 MAIL
ADDRESS OL %7Y L(Av
N0.OF BLDGS. ^/
SIZE OF LOT NOW ON LOT CITY
TEL. NO
USE OF
BUILDINGS DISTRICT NO. G BK MAP
PG `PRO E T
CONTRACTOR _ � '.RJI��-
ADDRESS a yoCONNECTIO DATA
CI Lam' TEL.NO. 3v STATION �� DEPTH j
REGISTRATION NO. L — — B COUNTY STATE
MANHOLE REFERENCE
No. I DESCRIPTION OF WURA FEE
HOUSE SEWER CONNECTING TO '1
PUBLIC SEWER @ 53.00 O(J TYPE OF CONNECTION LENGTH FROM
PITS AND/ORIC •DRAINFII SEEPAGE OR @ $3.00 T. CURB P.L. N.L.TO P.L.
OVERFLOW SEEPAGE PIT.GRAINFIELD --
EATN..CESSPOOL.DRYWELL @ 52.00 1
HOUSE SEWER CONNECTING TO P. Q
PRIVATE DISPOSAL SYSTEM @ SI.00 CO.IMP. N0. _JOY-M9: LJ •--� V
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER ca Sf.00 TRUNK PERMIT N0. ROAD PERMIT X0. y.
ALTER,REPAIR OR ABANDON HOUSESTATE ENCROACHMENT 0
SEWER OR DISPOSAL SYSTEM ca $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL N
CHARGES Z
OWNERS PERMIT $ .Z 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE C, REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAi
-
TRACTOR TO CONNECT THE ABOVE DESCRIBF,D EXISTING G APPROVALS DATE) INSPECTOR'SSIGjIAT RE
TO THE PUBLIC SEW�,@v/SIGNED THIS_r�_DAY OF q� NEW HOusE s6wEROWNER OR CONNECT ADDITIONALOWNERSAGENT� ls(<YBUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR GRAINFIELD
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APNANDSTATE THAT THE ABOVE IS CORRECT AND AGREE TY CESSPOOL ❑ DRYWELLWITH ALL COUNTY ORDINANCES AND STATE LAWS REG ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEN
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERER DISCONNECT PLUG AND
LICENSED AS REQUIRED B OSANGELES COUNTY AND F ABANDON HOUSE.SEWER
CALIFORNIA OR THAT 1 M THELEGAL OWNER F TE
DESCRIBED RESIOENTT ROP TY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS 11
OF PERMITTE
0 AMATION ROBERT A. WOOD
QX. M.o. CAXH SUPERVISING MECHANICAL ENGINEER
� �'7 1 6 7 JAN 17 1 0 D 5 .07 0 M