HomeMy Public PortalAbout5802 GOLDEN WEST AVE_Sewer__ - z
, D
cE808 APPLICATION FOR PERMIT
esoe 11-57APPLICATION'
OF LOS ANGELES ,_',
DEPARTMENT OF-COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING a
JOHN A. LAMBIE, County Engineer' ADDRESS `7'4' i '
CASSA1T D. GRIFFIN, Supt of Building + = i
LOCALITY G' +
NEAREST
FOR APPLICANCT TO FILI. IN CROSSST., L.U_v s/I�'vmc�✓I
LEGAL
DESCRIPTION LOT NO. ..? OWNER
BLOCK TRACT MAILNO,OF `'�. + (y-O/ �' Ups'•
ZE OF LOT-5'6 NOW ON LOTS CITY p•
i _TEL.N0.�41,
USE OF
BUILDINGS DISTRICT NO, GROUP MAP
CONTRACTOR ya- G { PPG
ADDRESS Qa CONNECTION DATA
CITY -77C TEL.N0. 4 0>1`5 STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. COUNTY LOWER
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $3 50 -
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB 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. JOB NO.
CONNECT ADDITIONAL BLDG.-OW
TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE ,
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
,INDUSTRIAL
./ WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION 'TOTAL FEE' REIMBURSEMENT FEE
-DATE A CONTRACT-WITH THE HEREIN NAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. _ _ _
-SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR - - -- - - -•- - - -CONNECT'ADDITIONAL- --
OWNERS AGENT BUILDING OR WORK D
ADDRESS'- - - - - - - - SEPTIC TANK,SEEP;PIT(S) - - - -r •'f- -
AND, DRAINFIELD -
1 HEREBY ACKNOWLEDGE THAT ,I HAVE READ THIS APPLICATION
[AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL-❑ITH ALL COUNTY• ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
LUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM1 HEREBY CERTIFY THAT I AM- PROPERLY REGISTERED-AND/ORISCONNECT PLUG AND
ICENSED AS REQUIRE BYLOS ANGELES COUNTY AND STATE OFALIFORNIA OR-THAT I A_M THE LEGAL_OWNER OF-THE ABOY ABANDON HOUSE SEWERESCRIBED RESIDEN L P PEATY. BACKFILL SEPTIC TANKS ❑GNATURE SEEP PIT(S) ❑ CESSPOOLS ❑ �.
OF'PERMITI
amam
VALIDATIODI_ � ROBERT A. WOOD -
CK Y.0. CASH SUPERVISING MECHANICAL ENGINEER
- - - 1_AC06 7 7 a-- -NOV 18 10 —A 3.0.0