HomeMy Public PortalAbout4949 DOREEN AVE_Sewer__ 70k642D 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 77,
ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER �y
O CASSATT O. GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOS—tAPPP I ANT TO FILL IN i jl— CROSS ST.
LEGAL ..6'aT/f /`
DESCRIPTION LOT NO. SF OWNER ,
G
BLOCK � TRACT ��Z7�3u ADDR
SIZE OF LOT
NO. OF BLDGS. CITY TEL. NO.
NOW ON LOT
y USE OF DISTRICT NO. . GROUP MAP
BUILDINGS
CONTRALTO /] / '> IRK f 9
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ADDRESS �� W �,� ju,Q ` CONNECTION DATA
�`'_/ � � STATION DEPTH O
CITY TEL NO O_ / MANHOLE REFERENCE
L�
^� C3i STATE 1 t LOWER
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REGISTRATION NO. C— Y ^
NO. DESCRIPTION OF WORK FEE TYPE OF C.Ory(♦_ECTION LENGTH FROM p . 1
HOUSE SEWER CONNECTING TO 2'TI : Y. rCURB� P.L. M.L. TO P.L.
!fG a
PUBLIC SEWER @ $3.50 L3
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD aq P. C. NO.
E%TN.,CESSPOOL DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. „r,� JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $ 1.00 TRUNK PERMIT NO. 'ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR _ STATE ENCROACHMENT
WORK TO HOUSE SEWER (D $1.00 - PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM CA S I.CO - WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORATION TOTAL FEE REIMBURSEMENT FEE v
IZ
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON. APPROVALS _ DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THAABOVRtBED E%I STING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER O' '
SIGNED THIS 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
` OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
4 PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY 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 OW OF THE ABOVE
` DESCRIBED RESIDENTIAL PRO Y. - BACKFILL SEPTIC TANKS❑
A
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS[I
OF PERMI
JOHN A. LAMBIE. COUNTY ENGINE5ff VALIDATION ROBERT A. WOOD.CHIEF PLBG. INSPECTOR
CK. e.0. CASX
Leo 2 2 5 3'ra, SEP 1 3 4 450 0