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CEA083420 APPLICATION FOR PERMIT
CE P
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAMBIE. County Engg��veer ADDRESS
WILLIAM A. IM SEN. 9up'1 of BuildivM LOCALITY h f= Tl
NEAREST
FOR APPLICANT TO FILL IN CROSS sr.
LEGAL
DESCRIPTION LOT NO. �� OWNER
BLOCK TRACT T AL
DDIRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS v DISTRICT NO GROUP MAP P OCESS Y
/
BE PO
CONTRACTOR )1],D?•U [ 111 GThing & Heating 6 O
', ADDRESS 13933 So . Crenshaw Blvd. CONNECTION DATA
CITY Hawthorne TEL.NO. OS 93169, 1 STATION DEPTH Q
REGISTRATION NO. 193617 C-36S'C a-❑ COUNTY STATE MANHOLE REFERENCE
NO. DESCRIPTION OF FEE �P G
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ OO TYPE OF CONNECTI LENGTH FROM /
SEPTIC TANK,SEEPAGE PIT OR 17-)
CURB M.L.T".L.
PITS PND/OR DRAINFIELD @ $B.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOO L.DRYWELL @ $2.00 R
III—
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ SLOG CO.IMP. N0. JOB N0. V
CONNECT ADDITIONAL SLOG.OR TRUNK PERMIT NO. ROAD PERMIT N C
WORK TO HOUSE SEWER $1.00
SEWER OR DISPOSAL SYSTEM HOUSE C.
$1.00 STATE ENCROACHMENT O
PERMIT NO. V
INDUSTRIAL a
WASTE APPROVAL N
����n�.,tTt�n� CHARGES z
OYTyY RAS PERMIT E 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT TRACTOR TO CIONNECT THE ABOVS DATE A E DESCRIBED EX WITH THE APPROVALS ED APPROVALS DATE INSPECTOR'S SIGNATURE
- TO THE PUBLIC SEWER. r ',f
SIGNED THIS DAY OF 19— NEW HOUSE SEWER J�7 I�2
OWNER OR CONNECT ADDITIONAL /
OWNERS AGENT BUILDING OR WORK /
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT C HAVE 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. SEWAGEEPAIR.SEWER DISPOSAL EM
I HEREBY CERTIFY TN I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THA' 1 THE LEGAL-0W1 R OF TI}E ABOVE
DESCRIBED RESIDE OPERTY cc / BACKFI LL SEPTIC TANKS El
SEEP.PIT(S) C] CESSPOOLS
OF PERMITTEE
VALIDATION ROBERT A. WOOD
CK.
H.Q. WM SUPERVISING MECHANICAL ENGINEER
._a2229 ' 1r 71 0 0 7.00 e
D
CS608. APPLIC TION FOR PERMIT
seoe-e-ae COUNTY OF LOS ANGELES '
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION ADDRESS
C
TORN A. LAM TE. County Enginoor E55 /
CASSATT D. GRIFFIN. Supt of Building LOCALITY
NEAREST
FOR PLIC O cgoss ST.
LEGAL OWNER .� ` 7
DESCRIPTIO 0 0.
BLOCK TRAC MAIL "
ADDRESS
N0OF BLD S, y
512E OF LOT /aJ NOW. ON LOT / CITY TEL.NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP - P OGESSED BY
' CONTRACTOR K PG J -
J
ADDRESS CONNECTION DATA
CITY F .N0. • / : STATION V DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO, Z., COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $3.00 C�U
SEPTIC TANK, SEEPAGE PIT OR TYPE OF TION LENGTH FROM
PITS AND/OR DRAINFIELD 0 $3.00 Y. UR P.L. M. 'TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
E%TN.,CESSPOOL,DRYW ELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO I P.C.NO.
PRIVATE DISPOSAL SYSTEM 0 31.00 CO.IMP.N0. JOB N0.
CONNECT ADDITIONAL BLDG.OR " TRUNK PERMIT NO. . ROAD PERMIT NO.
WORK TO HOUSE SEWER 0 $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM 0 $1.00 PERMIT NO.
INDUSTRIAL
" WASTE APPROVAL
CHARGES
OWIVER•S P�MIT $ 2 DO CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWE /'
SIGNED THIS '� DAY f �19� NEW HOUSE SEWER
OWNER OR `!J �1..�p71 CONNECT ADDITIONAL'
OWNERS AGE N BUILDING OR WORK
SEPTIC TANK, SEEP,PIS)
ADORES TAND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 VE 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. SEWAGEDISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - DISCONNECT AND '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND A
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE.ABOVE ,
DESCRIBED RE NTIA ROPERTY. SE
EP. PITBAC KLL(SEPTIC CESSPOOLS (J.C_./A'w.S
SIGNATURE
OF PERMITTEE
®c VALIDATION ROBERTA.WOOD
>M. u.a. CAiM sup
RRVI&ING MECHANICAL ENGINEER
CPi�1 a s huc 141 0 0 5 .0 0