HomeMy Public PortalAbout5036 FIESTA AVE_Sewer__ D
09808-8•SB APPLICATION FOR PERMIT 1'
E808-
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. IAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building LOCALITY 7 /��
NEAREST _
FOR APPLICANT TO FILL IN ceoss STLEGAL
.
DESCRI TION LOT N0. ®y. Q OWNER
BLOCK TRACTr MAIL
15 ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.N0.
USE OF
BUILDINGS _ DISTRICT N0. GROUP MAP PROCESSED BY
BK P6
CONTRACTOR' �.
ADDRESS
CONNECT I N DATA
CITY l �f EL.N0. I��er�% STATION t DEPTH
REGISTRATION NO. 9Ja � r ATE MANHOLE REFERENCE UPPER
LJ COUNTY J
No. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 -t) di®
SEPTIC TANK, SEEPAGE PIT OR TYPE OFTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CUR 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. JOBN0.
CONNECT ADDITIONAL BLDG.OR 0. ROAD PERMIT N0. L
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N _
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEWS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ® 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.
SIGNED THIS 0 I NEW HOUSE SEWER .
OWNER OR
OWNERS AGENT sy ` BUILDING ORDWORKAL
+�4 SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 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 REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT !)M THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI P OPERTY, BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP.PI (S) ❑ CESSPOOLS❑
OF PERMIT'F
®►.
VALMATION ROBERT A.WOOD
N.q, Gulf SUPERVISING MECHANICAL ENGINEER
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