HomeMy Public PortalAbout4909 FIESTA AVE_Sewer__ 7BABd2D
CE808 11 57 APPLICATION FOR PERMIT � y
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL `
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O `
JOHN A LAISW E County En eer ADDRESS
CASSATT D GRIFFIN Supt of Suddmg ,
LOCALITYjNEAREST
FOR APPLICANT TO FILL IN CROSS ST `
r
LEGAL }
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL y11
ADDRESS
NO 0 BLDGS
SIZE OF L (!/ NOW LOT CITY TEL NO 7 r f
USE OF
BUILDIN DISTRICTI GROUP I MAP
CONTRAC J �BK
ADDRESS ... CONNECTION DATA
CITYSTATION �" S DEPTH
Q
STATE MANHOLE REFERENCE / UPPER
REGISTRATION NO u COUNTY / LOWER
NO DESCRIPTION F WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3
SEPTIC TANK SEEPAGE PIT OR TYPE OF CT N LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y allRB P L M L TO P L
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00 STATE ENCROACHMENT
PERMIT NO
NDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE w ®� REIMBURSEMENT FEE
CON
TRACTOR TO CIONNECT THE ABOVDATE E DESCRIBED EXISTWITH IINGAMED DWELLIING APPROVALS DATE INSPECTOR S SIGNA RE
TO THE PUBLIC_SEWER_
SIGNED THIS-DAY Y I LL NEW HOUSE SEWER
OWNER OR - -CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS' AND/OR DRAINFIELD
I EA
HEREBY AC OWLEDGE THAT I RD THIS APPLICATION
AND STATE THAT THE ABOVE IS C ECT AND AGREE TO COMPLY -CESSPOOL Cl DRYWELL❑ -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
_SEWAGE DISPOSAL SYSTEM-- -
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND v w
LICENSED AS RE UIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIWER
DESCR R IA OR THAT I R TPEpf _OWN R-OF Tit ABOVE
DESCR RE DENTIAL AM
BACKFILL SEPTIC TANKS ❑
U ' SEEP PIT(S) ElCESSPOOLS
Or - " J^r —� V A'I'IOIp _ ROBERT A WOOD -
CK m 0 CASH/ SUPERVISING MECHANICAL ENGINEER
i
(„�2842°'; -FEB 271 0 A - - 600