HomeMy Public PortalAbout4802 FIESTA AVE_Sewer__ 76A64 10_62 APPLICATION F®I® PERMIT
76A 842D A-S R9%ll
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building
LOCALITY -�/y�/1iC
' NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NOl OWNER
MAIL �I
BLOCK TRACT ADDRESS /V
NO. OF BLDGS.`
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. GROUP BK MAP PROCESSED BY
BUILDINGS �' /fir+'-� �/p,
CONTRACTOR / 7 <� J / �S�PG
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ADDRESS OV1417 6ACLOr//• � a CONNECTION DATA
f
CITY/3rqs,���>/6q 411L. NO. f STATION DEPTH�y / ® v
UPPER
REGISTRATION NO. MANHOLE REFERENCE
E
IG✓ $ �b ❑ COUNTY LOWER
NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $5.00
P.C.NO.
SEPTIC TANK.SEEPAGE PIT O R
PITS AND/OR DRAINFIELD @ $10.00
CO.IMP.NO JOB NO.
HOUSE SEWER CONNECTING TO T ` IT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR - AFFIDAVIT WAI R EASEMEN E ORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD _
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00
p AIL'FE R, HOUSE HWY.OR ST.WIDENING
( SEWER EM @ $3.00 �® STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 2 Oo
AUTHORIZATION TOTAL FEE �^ 0 CONNE ON CHARGE FEE CHARGES
'
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWEyg. �7' / APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OFT." 19J3
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR _ r
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO - DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCCR,I�BED RE PDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE //j' O
OF PERMITTEE A/(Ai /J�.( BACKFILL SEPTIC TANKS ❑
SEEP,PIT(S) ❑ CESSPOOLS ❑
ALIDATION ROBERT A. WOOD
O. CASH SUPERVISING MECHANICAL ENGINEER
7