HomeMy Public PortalAbout5022 DOREEN AVE_Sewer__ '°""2°
689 12.54 APPLICATION . FOR PERMIT
5 G E
' DIVISION OF BUILDING AND SAFETYSEWER—SEWAGE D I S POSA L
(Department of County Engineer - (1
County of Los Angeles BU u.DIHG �Qa� �OYC PAI `
WM. J. FOX, COUNTY ENGINEER ADDRESS
H CA65ATT D. GRIFFIN. 6VP'T of 6DIEe1NG LOCALITY `re A, c. f--
FOR APPLICANT TO FILL IN NET
LEGALf C ^ CHOPS ARESST �.
. p V
D SCRIPTION LOT NO.So fJ a ' (1 �" OWNER A .
BLOCK TRACT MAIL ESS
S4o',e
9�= / _ADDR
SIZE OF LOT j-0 X 14 0 NOWOON LOTS
CITY TEL. NO.
USE OF j)
BUILD'NGS ' to S DISTRICT NO. GROUP MAP
(� BK PG p
CONTRACTOR /t/� �"1 C l� SPU 1�tt ���- S(j N - X
L ADDRESS ill!j 6 k-A-1 C I w I T'ai CONNECTION DATA 1
CITY fYp S P AAA � A TEL. NO. A.�� 6 J ! - STATION / f, j DEPTH
�! @r-STATE ry P MANHOLE REFERENCE
REGISTRATION NO. 7 0 El COUNTY — /L� 0y .moi� UPPER LGiINIT
TYPE OF C�iN CTION LENGTH FROM �•�
NO. DESCRIPTION OF WORK FEE v. �eRR®-1 P.L. M.L.TO P.L. V
HOUSE SEWER CONNECTING TO
PUBLIC SEWER (a) S 3.50 -3 7� -
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
WORK TO HOUSE SEWER CONNECT ADDITIONAL BLDG. OR 100 CO. IMP. N0. f -43 n JOB. NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAR PERMIT NO.L '1
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0. /
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFEELD 2.00 INDUSTRIAL
CESSPOOL- DRY4V E'LL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CH P
CONNECTION CHARGE i'
OWNERS PERMIT 5 1 00
AUTHORIZATION TOTAL FEE __q—15;76—
U REIMBURP'A1BV FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS 0 TE INSPECTOR•S SIGNATUR
THE PUBLIC SEWER
SIGNED THIS DAY OF � �'I � 1B�!' NEW HOUSE SEWER /D �
OWNER OR / CONNECT ADDITIONAL
OWNERS AGENT_' BUILDING OR WORK
ADDRESS 4__- J�(1�'• o.PN SEPTIC AND/OR GRAINFIELD
GRAINFIELUPIT(S)
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
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. �/ BACKFILL SEPTIC TANKS❑
A aIDScod/ CI"�SS N' /;/ SEEP. PIT(S) ❑ CESSPOOLS Cl
SIGNATURE
OF PERMITTE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
2 3 4 5S APR 6 4 4.5 0
BY BY �//� — -
1 DEPUTY �/. DEPUTY
BY ` J BY
,® ^ DEPUTY DEPUTY