HomeMy Public PortalAbout5101 GLICKMAN AVE_Sewer__r
768948° »cesoe O.ss APPLICATION FOR PERMIT 7
COUNTY OF LOS ANGELESi.
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRBUILDESING
S J /�
TOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building LOCALITYNEAREST .
FOR APPLI ANT TO FILL IN CROSS ST. Ct4
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LEGAL
DESCRIPTION LOT N0. OWNER
BLOCK TRACT MAIL
ADDRESS p
SIZE OF LOT��.°J f` NOW ON LOTS d CITY I h �:-Com;° �^_° TEL. NO. G'Ja r t`f
USEOF
DI (J A ( � DISTRICT NO. GROUP MAP P CESSED Y
BUILDINGS „�ia�G '4KMBK PG
CONTRACTOR `�� _�
ADDRESS CONNECTIO DATA
CITY re 7E L.N0, pp�: r C C C !i STATION DEPTH �/� ft
REGISTRATION NO. S L �t ,� ❑ COUNTY STATE
MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @-$3.00 - TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR - Y. CURB P.L. M.L.TO P.L. ...,,r
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ S2.00 , . C
HOUSE SEWER CONNECTING TO 88--)•MP"7�� 'paO
CC.N NO
PRIVATE DISPOSAL SYSTEM @ $1.00
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT NO.
_ •
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. -
INDUSTRIAL
WASTE APPROVAL
/ICKABZES
OVVNERrS PERMIT $ 2 00 eaNmEevom
AUTHORIZATION TOTAL FEEI HAVE AT �� i?'� RJ;LE6811RSR• FE I NAMED CON. tlls y
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXS DATE A CONTRACT WITH THE ISTING DWELLING APPROVAES DATE INSP TOR' S1 NAT E
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR ,s CONNECT ADDITIONAL
OWNERS AGENT Al �' BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
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 1 AM PROPERLY REGISTERED AND/OR 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 RESIDENTIAL_PROPERT BACKFILL SEPTIC TANKS ❑
SIGNATURE yyy SEEP.PIT(S) 11 CESSPOOLS E:1
OF PERMITTEE_ Com• ° Y
ALIDATION ROBERT A. WOOD
CK. Y.o. CASH SUPERVISING MECHANICAL. ENGINEER
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