HomeMy Public PortalAbout5208 DOREEN AVE_Sewer__ S&Eaa 311.5, APPLICATION FOR PERMIT 1
DIVISION. OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL -
Department
ISPOSAL -Department of County Engineer -
County of Los Angeles BUILDING [—;/p O
JOHN A. LAMBIE. COUNTY ENGINEER AOORE55 9
O a( 75
® CASSATT D. GRIFFIN. SDP'T of BUILDING LOCALITY
BrE3
FOR APPLICANT TO FI/L,L IN caoss si.
DESCRIPTION LOT NO. Q� �J OWNER I
MAIL
BLOCK TRACT'I/ pODRE55
9A�Y2 NO. OF BLOGS./
SIZE OF LOT aG NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS DISTRICT.
N0. GROUP MAP
BK
CONTRACTOR
17?d
CONNECTION DATA
ADDRESS nn
CITY LN
Y _ O STATIONA D._ DEPTH
E . Q MANHOLE REFERENCE /
hy STATE i OWER
REGISTRATION NO. U ! ❑ COUNTY
NO. DESCRIPTION OF WORK FEE All
HOUSE SEWER CONNECTING TO nc TYPE OF CO RB CTIONP L MELGTOH F LOM f�
PUBLIC SEWER @ pav Y .�� oA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C.EXTN, O.
OVERFLOW
POO AGE YWEL RAIMANHOLE @ $2.00 CO. IMP. N0. POB NO.
HOUSE SEWER CONNECTING TO 3 a .
PRIVATE WEE SAL SYSTEM Q 51.00 TRUNK PERMIT N0. ROAD PERMIT N aq i /7
CONNECT ADDITIONAL BLDG. OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO. '
ALTER.REPAIR OR ABANDON HOUSE - INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
//CHARGES/ y
CONNECTION CHARGE"FEE'.C�IS•i•Lh F/.l Ys ���
OWNER'S PERMIT S 00 REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE r O
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
I
(�1y
TO THE PUBLIC SEWER. / NEW HOUSE SEWER . 13 S51 C^ .A•-L+,��_
SIGNED THIS If DAY OF 19_L CONNECT ADDITIONAL
OWNER OR BUILDING-OR WORK
OWNERS AGENT SEPTICTANK,SEEP,PIT(S)
ADDRESS ND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[:3DRYWELL❑ -
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. ` SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTYDISCONNECT PLUG AND
AND STATE OF ABANDON HO PLUGUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERT - BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S) (3CESSPOOLS O
OF PERMITTE Au� "
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIE .tB P TOR
CK. Y. O. CASH A t/
UT105 P,PR 20 1 0 A 5.00 n