HomeMy Public PortalAbout9041 EMPEROR AVE_Sewer__ E808.D
C 8.88 APPLICATION FOR PERMIT
E808.
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Fmgineer
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
NEAREST
FOR eAPPLICANT TO FILL IN CROSS .
LEGAL ' OWNER
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
N OON L S.
SIZE OF LOT N WLOT CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP b � jOCZESSY
BK PG
CONTRACTOR
ADDRESSas CO ECTION DATA
CITY TEL. NO. STATION � DEPTH
STATE MANHOLE REFERENCE UPP
REGISTRATION NO. ® COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR
ORK TO HOUSE SEWER $1.00
TRUNK PERMIT N0. ROAD PER 0.
W @
SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STA-,E ENCROACHMENT
_PERMIZ N0.
INDUSTR
_WASTE APPROV
C
OWNER'SPERMIT $ 2 00 CONN ION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE /.4(?
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE' INSPE TOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIN WELLING
TO THE PUBLIC SEWER. /! ,,t/�• -'�
SIGNED THIS Al( OF Ig NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP, PITS)
AND/OR DRAINFIELD
I HEREBI ACKNOWLEDGE THXf I HAA 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 ABANDON HOUSE SEWER
CALIFORNIA OR THAT I THE LEGAL 0 T E ABOVE BACKFILL SEPTIC TANKS❑
DESCRIBED RE5IDENTi PRO ERTY.
SEEP.PITS) ❑ CESSPOOLS
SIGNATURE
OF PERMITTE
®a VALIDATION ROBERT A.WOOD
'' C
CK. M.0. ASV SUPERVISING MECHANICAL ENGINEER
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