HomeMy Public PortalAbout5030 FIESTA AVE_Sewer__ 78A842D ® LIT' ®® E ERMIT
CE808.8-58 �" 7
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL i■
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAM IE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building LOCALITY !�
NEAREST
FOR APPLICANT TO FILL IN CRoss ST.
_ o
LEGAL /►
DESCRIPTION LOT N0.Z'C'C� f JT OWNER J/T✓ L%�
BLOCK TRACT ` 3 2 ADAESS
ESS
NO.OF BL
SIZE OF LOT "s� 12-L3NOW ON LOT
CITY • _TEL.NO.
USE OF
BUILDINGS �i� DISTRICT NO. GROUP MAP P OCESSED Y
HK PG
CONTRACTOR' ,V�.� O�( , ►
ADDRESS �9 Geyf S,- O CONNECTION DAT
CITY e a� TEL. N0. ��Y �j STATION �� DEPTH
STTEAMANHOLE REFERENCE UPPER
REGISTRATION N0. O
' NO. DESCRIPTION OF WORK FEE
/ HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 D�
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y•- CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO PIC.N0.
PRIVATE DISPOSAL SYSTEM (� $1.00 .NO. J N0.
` CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROAC ENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE AL
CHARGES
OWNER'S PERMIT $ 2 OC CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 0 REIMBURSEMENT 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. Ci
SIGNED THISAY OF 19_ NEW HOUSE SEWER
OWNER OR l� CONNECT ADDITIONAL '
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND.STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
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 EGIST BED AND/OR DISCONNECT PLUG AND
LICENSE REQUIRED tY OS AN LES OUNTY ND STATE OF ABANDON HOUSE SEWER
CALIFOf{NtA THAT I „A TA 'Al OW OF'THE ABOVE
DESCRIBED\REST NT AL P SEEP.ILL PIT(S)
TANKS[I ❑
SIGNATURE �-
OF PERMITTE
FA
®P ALIDATION ROBERT A.WOOD
cK. M.D. CASH SUPERVISING MECHANICAL ENGINEER
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