HomeMy Public PortalAbout5225 DOREEN AVE_Sewer__ 88420
CEeoeBea, APPLICATION- FOR PERMIT
c2 . COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION - eUD LDING
ADDRESS - (. _
NN A. LAMBIE, Counlp Engineer
CAC
-
SAT7 D. GRIFFIN, Sup I of Building LOCALITY 7, ri `1
NEAREST -
FOR APPLICANT TO 'FRI. IN DRoss sT.
LEGALOWNER O -
DESCRIPTION LOT N0.
BLOCK C TRACT / �7 MAIL 1 -
C/ ADDRESS
N0,OF BLDG9_. - -
SIZE OF LOT J' NOW ON LOT CITY TEL. NO.,.
USE OF x
BUILDINGS ��� �� - DISTRICT NO. GROUP I _�, MAP_PG _ I P CESSED
CONTRACTOR T' 42471
V
ADDRESSl 5'j CONNECTION DATA
' CITY TEL.NO.h STATIONDEPTH Y
STATE MANHOLE REFERENCE
REGISTRATIONNO. O B COUNTY ^^ER
No. DESCRIPTION 0 WOR EE -
HOUSE SEWER CONNECTING TO � }} _
PUBLIC SEWER @ $3.00 "7 Gam/ TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB' P.L. M.L.TO P.L.
–
PITS AND/OR DRAINFIELD @ $3.00 I'7
OVERFLOW SEEPAGE PIT. DRAINFIELD / /n
EXTN,.CESSPOOL.DRYWELL @ S2.00
PRIVATE DISPOSAL SYSTEMTO - @ $1.00 CO. IMP, NO. 07 JOBB NO. ljzl
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. L
WORK TO HOUSE SEWER @ SI 00
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ 81.00 PERMIT NO.
INDUSTRIAL - _
' WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION 'TOTAL FEE 6�-O REIMBURSEMENT FEE -
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING .APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. -
SIGNED THIS DAY OF 19— NEW HOUSE SEWEROWN ER OR �/1 r^ )itl CONNECT ADDITIONAL-
OWNERS AGENT Ifp' /G YG BUILDING OR WORK -
ADDRESS SEPTIC TANK,SEEP.PIT(S) -
AND/OR DRAINFIELD
.1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ -
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 DISCONNECT PLUG AND
-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISC O N CT PLUGHOUSE A D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDBACKFON
SEPTIC TANKS ❑
ER
DESCRIBED RESIOENTIA PROPERTY. SEEP.PIT(S) ❑ CESSPOOLS ❑ -
SIGNATURE -
OF PERMITTE
® VALIDATION` ROBERT A. WOOD
CK. M.0. l CASH SUPERVISING MECHANICAL ENGINEER ,
L1CO8.0 2 42� MAR 2 2 1 O A 5.0 0. .n.