HomeMy Public PortalAbout9408 EMPEROR AVE_Sewer__ _ 1
S&E 6D8APPLICATION FOR PERMIT 1
E DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING OW ��✓
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® %/
CASSATT D GRIFFIN SUP T OF BUILDINR LOCALITY A 4
NEAREST
FOR F&PYLICMT TO FILL I,� CROSS ST m
3 t3 � sem,.
DE CRIPTION LEGAL / LOT NO ��-3�� '��aFMAIL
/�/.� � Q OWNER � '- '�, � •?e �,�
BLOCK TRACT � e ADDRESS a�
/� NO OF BLDGS
SIZE OF LOT (pM 5?3NOW ON LOT CITY -TEL NO
USE OF ,�' DISTRICT NO GROUP MAP
BUILDINGS �� �' BK PG
La
CONTRACTOR - Jd
-37A
ADDRESS Af� � CONNECTION DATA
STATION DEPTH J
CITY r TEL NO �7 f`
MANHOLE REFERENCE
TATE �` LOWER
REGISTRATION NO 7 ❑ COUNTY
NO DESCRIPTION OFWORK/ FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM E
Y CURB PL M L TOPL
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EXTN CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP NO �,� JOB NO
HOUSE SEWER PRIVATE DICONNECTING TO
DISPOSAL SYSTEMQ $1 00 TRUNK PERMIT NO ROAD PERMIT NO�D 9of —
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT $ t 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HERE16 NAMED CON. APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR 1 BUILDING OR WORK
OWNERS AGENT /a,GL/ SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ 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 -
IHEREBY CERTIFY THAT I AM PROPERLY,-,REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY D
�L+OS ANGELE COUNTY AND STATE OF ABANDON HOUSE SEW
CALIFORNIA OR THAT IAM E LE L OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIALiP OP BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(s) ❑ CESSPOOLS _
OF PERMITTEE
JOHN A LAM I COUNTY ENG R VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CASH
,00 2 4 5 JUL 16 4 4.55 0 `�