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CE808-$-$8 APPLICATION FOR P RMIT 1.
E80$-
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEARES7T
BUILDING
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building
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LEGAL FOR APPLICANTTOFILL IN q!Oss sT.
_DESCR
IPLOT NO. L�Ly9'Z 14 t �'J OWNER
BLOCK TRACT AIL
�1 p DRESS U 1,1_V�2— 7 _ re
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NO. OF BLDGS. s
SIZE OF LOT „S /�i� NOW ON LOT I CITY TEL.NO.
USE OF h
BUILDINGS DISTRICT NO.1 GROUP I
BK PG MAP PROC SED BY
CONTRACTOR F^ 'toll(G� �Q
ADDRESS G � CONNECTION DATA
CITY p� TEL.NO.C STATION,` DEPTH
4VREGISTRATION N0.
��, ✓�� ❑❑ S MANHOLE REFERENCE UPP
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
PETS AND%OR DRAINFGELD TOR @ $3.00 CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 +!/
HOUSE SEWER CONNECTING TO
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 STATE ENCROAtiikENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
° WASTE APPROVAL
CHARGES
OWNER'S` PERMIT g 2 00 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. / / c
SIGNED THIS DAY F 1 19— NEW HOUSE SEWER /^�� /`/ .? ,.L�/ • ,�
OWNER OR 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
1 HEREBY CERTIFY THAT I AM PROPERLY RE ER ND/OR DISCONNECT PLUG AND
LICENSED AS UIRED BY OS GELE COU A ST TE OF '- ABANDON HOUSE SEWER
CALIFORNIA (OR T I M T E OWN R F TH ABOVE
DESCRIBED SIDEN AL RO Y BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) El CESSPOOLS [ISIGNATURE -�
OF PERMITTEE
®r LIDATION ROBERT A.WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
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