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Home My Public Portal About5732 GOLDEN WEST AVE_Sewer__ CE6DB ,2-68 _ APPLICATIO FOR PEFt IT 6A 64 D 72u COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING (� JOHN A. LAMBIE. COUNTY ENGINEER fNEAREST DDRESS V COLEMAN W. JENKINS. SUP T OF BUILDING OCALITY /may i FOR AP CANT TO FML IN ROSSST L/0� LEGAL rs p_ DESCRIPTION LO O OWNER f MAIL BLOCK -/RACT ADDRESS NOBLDI1 SIZE OF LOT NOWOON LOT S CITY TEL USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY BK PG CONTRACTO ADDRES '� 1 CONNECTION.DATA CITYTEL _ �� STATION DEPTH I (P ¢ ` ' UPPER STA E LIC MANHOLE ENC U ,V LOWER LICENSE NO /w© CLASS EF Rl� NO DESCRIPTION OF WORK FEE TYPE F TION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL M L TOP L PUBLIC SEWER @ i6 00g Q SEPTIC TANK SEEPAGE PIT OR JOB NO C NO PITS AND/OR DRAINFIELD a $1000 CO IMP NO s� HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT ryo� PRIVATE DISPOSAL SYSTEM @ $300 cr O CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE V WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD r Q= EXTN CESSPOOL ORYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING C~.3 SEWER OR DISPOSAL SYSTEM $3 00 LILJ STATE ENCROACHMENT CL PERMIT NO Coe) INDUSTRIAL Z WASTE APPROV AL OWNERS PERMIT E 2 00 CHARGES AUTHORIZATION rTOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO-CONNECT THE ABOVE DESCRIBED EXIST NG DWEL TO THE PUBLIC SEWER / APPROVALS D TE 1 ECTOR'S SI ATURE SIGNED THIS DAY OF J 1 OWNER OR NEW HOUSE SEWER � OWNERS AGEN CONNECT ADDITIONAL BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP,PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREB ERTIFY TZYOS M PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR LICE NS A REQUIREANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CAL RNI OR THAT LEGAL WNER OF ANDINTE D TODISCONNECT PLUG AND R DE I BO EBED j51 ENTI 'L R RTY ABANDON HOUSE SEWER IG ❑ OF P TT7EE f BACKFILL SEPTIC TANKS SEEP PITS) ❑ CESSPOOLS /VA TION JACK R. ALLEN CK M O CASH SUPERVISING MECHANICAL ENGINEER 9 � s ?� x '131 a D 7.00 r, � . !e;i.