HomeMy Public PortalAbout5024 FIESTA AVE_Sewer__ D
S&E 663 11 S'S
APPLICATION FOR PERMIT 1
5 8:E 6
DIVISION OF BUILDING AND SAFETY SEWER-SEW E DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY �1s�
FOR APPLICANT TO FILL IN CROSS ST
LEGAL OWNER v
DESCRIPTION LOT NO
BLOCK TRACT �? .Z ADDRESS
NO 0 BLDGS / CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF ,At DISTRICT NO GROUP MAP
BUILDINGS JWP BK PG
CONTRACTOR - � _'!5 I i
ADDRESS COONNECTION DATA p0
STATION
7 DEPTH Ls� J
CITY L NO Q B'^�� MANHOLE REFERENCE UPPER
T
REGISTRATION NO _ / COUNTY }� 1y ,+ 'z LOWER
o �� El
DESCRIPTION OF WORK FEE —& ' a�1 �4.2Iy
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
@ $3 50 Y CURB P L M L TOP L
PUBLIC SEWER —
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE Q $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 _PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 B� WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER I O r 1 AAA _
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTICTANK 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI L PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) F-1CESSPOOLS❑
OF PERMITTEE y
JOHN A LAMBIE COUNTY ENGINEER VALIDATIOhL, ROBERT A WOOD CHIEF PLBG INSPECTOR
1 1 4K4 5�
- OCT �s 4 200 h -