HomeMy Public PortalAbout5225 GLICKMAN AVE_Sewer__ T:fiT'LE CITY
CE808 3-
76A642D62 APPLICATION FOR PERMIT �
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESS
G 52 5 N• 1C All
Ave .
JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Supt of Building pYle City
Randwiek Dr.
TFOR APPLICANT TO FML IN ST.
LEGAL }�
DESCRIPTION LOT NO. 25 OWNER Weber Det.
I MAIL •04 yBLOCK TRACT 2 3o ADDRESS ieJV •
NO. OF BLDGS •
SIZE OF LOT NOW ON LOT CITY TEL. NO. R1 R
USE OF
BUILDINGS DISTRICT flGROUP MAP PROCESSED BY
�'c}`a' BK PG
a�I /,) 9
CONTRALTO nBeVe.aa. U � �
ADDRESS 3245�1N N. (I�var AV@• CONNECTION DATA
CITY So . 3 �Aan qDi j�rel . STATION p DEPTH
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION e'\ LENGTH FROM
1 HOUSE SEWER CONNECTING TO Y. CURB p, M.L.TO P.L.
PUBLIC SEWER @ $5.00 If! -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $10.00 CO. IMP.NO. JOB NO. V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. �.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVES EASEMENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL,DRYWELL,MAN HOLE @ $5.00 -a
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
�j} - WASTE APPROVAL
M-
O NER�S PERMIT $ 2 00 CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF Ig_ 1 -
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ CONNECT ADDITIONAL
ADDRESS
BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAT NFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY OR S AND STATE LAWS REGULATING
PLUMBING AND BE CESSPOOL El DRYWELL [31 HEREBY CE THAT i M PROPERLY REGISTERED A D/OR ALTER,REPAIR.SEWER OR
LICENSED ASUI RED BY OS ANGLES COUNTY AND ST E OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA THAT 1 AM,Y HE LEGAL OW R OF,.AND IN NO TO DISCONNECT PLUG AND
RESIDE IN, E ABOVE, ES
CRI BED RE TIAL ROPE Y. ABANDON HOUSE SEWER
SIGNATURE _
OF PERMIT t BACKFILL SEPTIC TANKS ❑
SEEP.PITT(S) ❑ CESSPOOLS ❑
ALIDATIO�;)
ROBERT A. WOOD
M.O.
SUPERVISING MECHANICAL ENGINEER
G