HomeMy Public PortalAbout4820 DOREEN AVE_Sewer__ 44
S&E-62°6 3 12-56 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM. J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY �i Y
FOR APP CANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO, f OWNER
BLOCK JRWAI& MAIL
ADDRESS
NO. BLDG .
SIZE OF LOT NOW N LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GGRROUP MAP
BK PG
T
CONTRACTOR 'm
ADDRESS CONNECTION DATA
O
CITY TEL. N0. STATION �&f� DEPTH
� TATE - / 9/ f (� MANHOLE REFERENCE S
REGISTRATI L 2// ❑ COUNTY JCO /y V
TYPE OF ECT IONP.L
LENGTH FROM
ESCRIPTION
No. DOF VJORK FEE Y. B P.L. M.L,TO P.L. W
/ HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ROUBLDG. OR
WORK
ORK C HOUSESE SEWER
CO. IMP. NO.R f.00 _
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT.AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
.SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNERS
PERMIT 1 00 CONNECTION CHARGE FEE
$
AUTHORIZATION TOTAL FEE O REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE 0 RIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC 5 ER
SIGNED THIS • DAY OF •`+• Q NEW HOUSE SEWER 41
f
OWNER OR L CONNECT ADDITIONAL
OWNERS A `E`NT L�I,i;,� Ri n BUILDING OR WORK
qq AA
AODR ESS f/• 71 'btlL,.� ._1 `'. SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ pRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO C014PLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEY
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF T E ABOVE
pESIBEO RESIDE TIAL ERTY BACKFILL SEPTIC TANKS❑
�(/�' SEEP. PIT(5) CI CESSPOOLS CIF PERMITT
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
'Eal 4 4 7,- JAM 4 4 4.5 0 m
By By
DEPUTY DEPUTY
r seBY By
® DEPUTY '� DEPUTY