HomeMy Public PortalAbout5624 / 5628 GLICKMAN AVE_Sewer__r -
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� 'eA6Az° APPLICATION FOR PERMIT
CE808-6-58 COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION EUILDING /
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building _LOCALITY
. �w- mi NEAREST
FO A PLI T TOCROSS ST. iG
LEGAL L - ,
DESC PTION LOT NW. r' MAIL
ER
BLOC Y
KESS
NO. OF BLDGS.SIZE OF LOT NOW ON LOT / Y TEL.N0.
USE DI J DISTRICT NO. GROUP MAP P SSED BY
BUILDINGS �. �S'/�:7�f ii��� y/ _j•$K PG
CONTRACTOR . l�A• r/ LL
ADDRESS �' �, J f� CONNECTION DATA
CITY EL. N0. STATION A- � DEPTH
` J �` r 4 R—ITATE MANHOLE REFERENCE
REGISTRATION N4" /(c. ❑ COUNTY — r � 20YLOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 YPE OF CONNECTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR y,
PITS AND/OR DRAINFIELD @ $3.00 -� / CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO P. C.
NO. ��
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. /
CONNECT ADDITIONAL BLDG. OR TRUNK PERMIT N0. ROAD PERMIT N0.
WORK C HOUSE SEWER @ $1.00 J Q4- f
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 FERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION I OTAL 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 DAY OF Ig-lr NEW HOUSE SEWER
OWNER OR ° - CONNECT ADDITIONAL
OWNERS AGEBUILDING OR WORK
ADDRESS - FEPTIC TANK, SEEP, PIT(S)
_AND/OR DRAINFIELD
I HEREBY CKNOWLEDGE 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 REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT L�PROPERTY. _ BACKFILL SEPTIC TANKS❑
SIGNATURE 1 SEEP. PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE
®� /' ALIDATION ROBERT A.WOOD
(`✓�,/ X.0. CASK SUPERVIrsING MECHANICAL ENGINEER
L�iLO 8 0 42"; J;' Z 6 1 L 5 r