HomeMy Public PortalAbout8835 ELM AVE_Sewer__ ,BA642D
CEBOe 6.89 APU LBC/!`tA tl SON FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, CounfF Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building LOCALITY 4r"� Ci/.�
NEAREST
FOR APPLICANT TO FILL IN CR SS sr.
LEGAL �� OWNER
' DESCRIPTION LOT N0. � i
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT \,� CITY TEL. NO.
USEOF DISTRICT N0. GROU MAPCES D'BY
BUILDINGS I ,
BK PG
CONTRACTOR `® P
w, ADDRESS CONNECTI N DATA
_- CITY^T�• /� T L.NO: f STATIONDEPTH
"
�+ p C�'STATE MANHOLE REFERENCE
w REGISTRATION NO. Ie,, G'.•a ❑ COUNTY ;' _ < 'V u. LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 ®b TYPE OF ION LENGTH FROM
e' SEPTIC TANK,SEEPAGE PIT OR y, CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TOP.C.NO. ,
PRIVATE DISPOSAL SYSTEM @ $1.00 A CO,IMP. NO, a 6 JOB NO.
0-0�CONNECT ADDITIONAL BLDG.OR l: TRUNK PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1.00 c
[�
AS
EWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
_ _ � PERMIT N0. -
u INDUSTRIAL ••
ti
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
_. AUTHORIZATION TOTAL FE REIMBURSEMENT FEE
I 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 SZ92 !//��// 191 NEW HOUSE SEWER
OWNER OR
OWNERS AGENT C,47- CONNECT ADDITIONAL `" ¢
T BUILDING OR WORK
ADDRESS / 1 L SEPTIC TANK,SEEP.PIT(S) -
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
_
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH A"LL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE REPAIRDISPOS.SEWER
EROR
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
YSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 THE LEGAL OW#Ef2�QF THE. ABOVE
DESCRIBED RESIDENTI R PERTY. BACKFILL SEPTIC TANKS
SEEP.PITS ❑ CESSPOOLS
SIGNATURE ,
OF PERMITTE
®° ATION ROBERT A. WOOD
C6 H.0. CASH SUPERVISING MECHANICAL ENGINEER