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HomeMy Public PortalAbout5029 DOREEN AVE_Sewer__ 1 •L.6 Q E-6312.34 APPLICATION TO.R PERMIT_ DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer _ - - County of Los Angeles BUILDING L �J A/ ADDRESS-�J��G �/Y• '/Z,-,,,/ WM. J. FOX, COUNTY ENGINEER" -CASSATT O. GRIFFIN,'60P'T of BmI.DING LOCALITY` FOR APPLICANT TO FILL IN CR0RSs ST. LEGAL DESCRIPTION - L 0 T N0. y Fid/�✓C�,4, L OWNER BLOCK_ �IA TRACT A DRESS i N . OF.BLDGS. SIZE OF LOT U NOW ON LOT CITY TEL. NO. USE OF / BUILDINGSlee, DISTRICT NO. GROUP GMAT BK. PG CONTRACTOR ADDREB .S' CONNECTION DATA - ITY–\ RO. �/ _ STATION DEPTH '!� G Epg'TATE /1 I� S MANHOLE REFERENCE " REGI RATION NO. q � ❑ COUNTY •• _ � - UPPER �LbRVM f, - -- TYPE NNECTION LENGTH FROM q b NO. DESCRIPTION OF WORK FEE Y. CURB P:L. M.L.TO'P.L. Cl 15 HOUSE SEWER CONNECTING TO �. PUBLIC SEWER $ 3.50 U l I HOUSE SEWER CONNECTING TO _ PRIVATE•DISPOSAL SYSTEM 1.00 _ CONN TO SEWER OR �h/'\ CO. IMP. NO. lo � , JOB. NO. ' WORK.TO HOUSE SEWER L00 �/SL f ALTER OR REPAIR EXISTING - ,(-F/ SEWER OR•DISP05.4L SYSTEM 1 1.00 TRUNK PERMIT NO. ROAD PERMIT N0. O( /1 Y '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 - 15PECIAL CO NOITIONS'ONLY 2.00 CHARGES PERMIT CONNECTION CHARGE FEE OWNER'S s A 00 AUTHORIZATION— TOTAL FEE REI M B U RSEMENTFEE I HAVE THIS IDATE,.CONTRACTED WITH THE.HEREIN-NAMED-CON- " TRACTOR TO CONNCCT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'5 SIGNATURE' TO THE*PUBLIC SEWER I _ - -' - NEW HOUSE SEWER - -" SIGNED THIS D Y 19— OWNER '" OR� ) L - CONNECT-ADDITIONAL - OWNERS AGENT�•� • �^�""�w'�V�� BUILDING OR WORK _. SEPTIC TANK-SEEP. PIT(S) w A DDRESG•- � > -tel/ �/����� AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL 0 ' AND-STATE THAT THE-ABOVE' IS CONNECT AND AGREE TO COMPLY - WITH ALL- COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER,OR PLUMBING ANO SEWERS. -„ _ _- SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS.REQUIREDBYLOS ANGELES COUNTY AND STATE OF ABANDON HO PLUGA D CALIFORNIA-CR-THAT I •AM THE LEGAL OWNER OF-THE ABOVE ' DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP.PIT(S) ❑ CESSPOOLS.[] SIGNATURE OF PERMITTEE- WILLIAM J. FOX, COUNTY ENGINEER VAIMATION' - &I rwer� -m 3% a -75`0BY t. OEP UTY /DEPUTY . + BY BY '© DEPUTY DEPUTY