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HomeMy Public PortalAbout8828 1/2 ELM AVE_Sewer__ S&E.16 311.55 APPLICATION FOR PERMIT DIVISION OF BUILDING ARID SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer o County of Los Angeles. BUILDINNEAREST i� �iL/�/ Alf. JOHN A. LAMBIE. COUNTY ENGINEER ® CASSATT D. GRIFFIN, SUPT of BUILDING ; LOCALITY _- -rr.+e•,- NEAREST , FOR APP- / CROSS sT. C, LEGAL / OWNER d e DESCRIPTION LOT NO. � . MAIL w it BLOCK TRACT // ADDRESS / SIZE OF LOT ©,X a'3t0 / NOW LOT BLOTS CITY 0- TEL. NO. USE OF uiEL-L/, , BUILDINGS � ifs/ y DISTRICT NO, GROUP MAP _ BK PG CONTRACTOR _ 44 a ADDRESSGJ/s� CONNECTION DATA -� ,j�� STATION - - DEPTH CITY TEL. fNIO. [J MANHOLE REFERENCE_ UPPER STATE of of REGISTRATION N0. /,- ❑ COUNTY ^� LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO14 LENGTH FROM PUBLIC SEWER @ $3.50 ' Y. CURB P.L. M.L.TO P.L. SEPTIC TANK,SEEPAGE PIT OR - - PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD �, P. C. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 CO. IMP, N0. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. R PERMIT NO. CONNECT ADDITIONAL BLDG.OR_ STATE ENCROACH ME - WORK TO HOUSE SEWER @ $1:00 `^ PERMIT NO, - ALTER,.REPAIR OR ABANDON HOUSE INDUSTRIAL - SEWER OR DISPOSAL SYSTEM -@ $1.00 WASTE APP OVAL - CHARGES F CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 REIMBURSEMENT FEE AUTHORIZATIORT I TOTAL FEE ° I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE,, TRACTOR TO CONNECT THE ABOVE DESCRIB D EXISTING DWELLING -TO THE PUBLIC SE EA. NEW HOUSE SEWER SIGNED THIS v Y O 19� CONNECT ADDITIONAL J OWNER ORr BUILDING OR WORK —�S�•fR•i9'7✓ OWNERS AG /y�� SEPTIC TANK,SEEP, PIT(S) ADDRESS G- AND/OR DRAINFIELD - I HEREBY ACKNOWLEDGE THAT I HAVE VREAD 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWDISCONNECT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ER DESCRIBED RESIDENTi LPROP T BACKFILL SEPTIC TANKS❑ SIGNATURE A' SEEP. PITS) ❑ CESSPOOLS C3 OF PERMITTEE G - . JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M.0,