HomeMy Public PortalAbout4949 FIESTA AVE_Sewer__ 3 11.55
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DIVISION OF BUILDING AND SAFETY SEWER-S.EWA-GE DISPOSAL
Department of 'County Engineer z'
County of Los Angeles BUILDING / k
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS � —T
J CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO ~FILL IN CROSS ST. �/
LEGAL OWNER // f.
DESCRIPTION LOT N0. .,� tl. "�. _ f_ j�
MAIL
BLOCK TRACT 13-3 � I/. ADDRESS
NO. OF BLD S!. r CITY TEL. NO.
SIZE OF LOT NOW ON LOT
BUELDFNGS� --v, .//P
_r,,,� �`z),=y.�('��'.^. X7 DI§TRICT NO. GROUP BK MAP
y / PG
CONTRACTOR /"��r•.. �. /s_y ., �.-y 9/
ADDRESS ti� ry -" l J CONNECTION DATA
STATION DEPTH {!�"
CITY,,°,/�,.�y, ✓ TEL. NO.
_ MANHOLE REFERENCE •
i , > � ❑ STATE LOWER
REGISTRATION N0, ,�+ ❑ COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF ON TION LENGTH FROM ga
HOUSE SEWER CONNECTING TO '-1 `°��g Y. g P.L. M.L.TO P.L.
PUBLIC SEWER @, $3.50 ``' V
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3..00
OVERFLOW SEEPAGE PIT, DRAINFIELD ? P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. - JOB NO.
HOUSE ER
PRIVATE DISPOSAL SYSTEMG TO @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT _
WORK TO HOUSE SEWER @ $1.00 n PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 . WASTE APPROVAL
CHARGES
CONNECTION CHARGE.FEE
OWNERS PERMIT $ 1 00
.: REIMBURSEMENT FEE
AUTHORIZATION TOTAL 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 SEWER. NEW HOUSE SEWER ,
h
SIGNED THIS DAY OFy 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT�� ✓, {tFt ,L�`r-c-` SEPTIC TANK,SEEP, PIT(S)
-> ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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 s. 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 RESIDENrT} S PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) El CESSPOOLS ?!Eu Tjj j (__
SIGNATURE 1
OF PERMITTEE (•� --�" '✓"�
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH `
4 1 .R MAR 15 4 4.5 0In