HomeMy Public PortalAbout4901-4907 FIESTA AVE_Sewer__ G
S&E-689 11.55 tl ■APPLICATION FOR PERMIT
1
9&E•8
DIVISION.OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles Bu1LDING ® dJ o
JOHN A. LA'MBIE. COUNTY ENGINEER J. ADDRESS
® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY _ /
FOR APPLICANT TO FILL IN "CROSSST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK - TRACT lily ADDRESS
k
N0. CITY
OF BLDGS.
SIZE OF LOT o ,��� NOW ON LOT � EL•
USE OF DISTRICT 0. GR P MAP
BUILDINGS �, _
BK
CONTRACTOR -, 4l,
�„ G
ADDRESS CONNECTION DATA
, �.,, �� STATION ®e DEPTH
CI _ TEL. N0. MANHOLE REFERENC 4 PPE
[I 'STATE 7TIR
Ai
REGISTRATION N0. ❑ COUNTY 0}A
No. DESCRIPTION EC WORK FEE TYPE S TION -LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EXTN„CESSPOOL,DRYWELL,MAN HOLE @ $2.00 CO. IMP. N0. � JOB NO.
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.31
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 6r(j PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL,
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 16
I HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- APPROVALS DATE INSPE•TOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - � NEW HOUSE SEWER ” "., �
SIGNED THIS DAY / 19 - CONNECT ADDITIONAL
OWNER OR V BUILDING OR WORK ,
OWNERS AGENT V �� SEPTIC TANK,SEEP,PITS)
0
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF D
ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE `
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) [:ICESSPOOLS 'Z' C
OF PERMITTEE
JOHN A. LAMBIE.COUNTY E46#, EER VALIDATION /� ROBERT
ART A. WOOD, CHIEF PLBG. INSPECTOR
CK. �B ��3 a°A0 t�c'O� i'rlll ',;,�. 4
6-5 `,..J �