HomeMy Public PortalAbout9432-9434 EMPEROR AVE_Sewer__ &E6D
S ' APPLICATION FOR PERMIT `
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IIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1
Deportment of County Engineer
County of Los Angeles BUILDING34,,32. 4 - emsfi, `
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY kA P LZ' C T'
OR APP A TO FILL IN CROSS T ,V F_~
LEGAL 'r I
DESCRIPTION LOT NO OWNER fL1
MAIL
BLOCK TRACT ADDRESSNO OF �
t
OF LOT L NOW ONBLOT S CITY L_1E TEL'NOINGS OF DISTRICT NO GROUP MAP
B PG
CONTRACTOR F,..�
ADDRESS �~ 0 f 7" CONNECTION DATA
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STATION at � DEPTH
CITY ,a TEL NO
��� MANHOLE REFERENCE
❑ STATE 3S— S LOWER
REGISTRATION NO ❑ COUNTY '
NO DESCRIPTION OF W07K FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM ) �+
PUBLIC SEWER @ $3 50 �� CURB M L TO P L O(-7
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE t@ $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG ORSTATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 Q PERMIT NO
ALTER' REPAIR OR ABANDON HOUSE ' INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
_ CONNECTION CHARGE FEE
OWNER'S PERMI S 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTA FEE
I HAVE AT THIS DATE A CONTRACT W ��11 THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESC .ED EXISTING DWELLING ['
TO THE PUBLIC SEWER- n NEW HOUSE SEWER ��u
SIGNED THIS DAY OF ;��' ��'/� 19� _ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT t �• -� ,// 'u i�R/'
�J1 SEPTIC TANK,SEEP, PIT(S)
ADDRESS �� "'? / "� .r AND/OR DRAINFIELD
1 HEREBY ACK OWLEDGE THAT I ,HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THA 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
I HEREBY CERTIFY THAT 1 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 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PR PERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) [:],CESSPOOLS
J
OF PERMITTEE J �y
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK N O CASH
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