Loading...
HomeMy Public PortalAbout5842 GOLDEN WEST AVE_Sewer__ CE606 5-65 76A 642D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOBN A LANIBIE, County Engineer ADDRESS COLENIAN W JENKINS Sup't of Building LOCAL TY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL I DESCRIPTION LOT NO OWNER MAIL 1 BLOCK TRACT A LSS 71 NO OF BLDGS SIZE OF LOT NOW ON LOT CITY, TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY L B K P� CONTRACTOR Q J ADDRESS ,/ CCONNECTION DATA CITY TEL NO �fj STATION f� "/ r DEPTH LICEN LICENSE �.•1 / 4 UPPER NO CLASS C �/ MANHOLE REFERENCE A NO DESCRIPTION OF WORK FEE TYPE OF CO ION LENGT ROM HOUSE SEWER CONNECTING TO $ 5 00 �D Y CURB P L M L T P L PTI TANK SEEPAGE PIT OR 7 PC NO CL PITS AND/OR DRAINFIELD @ $10 00, CO IMP NO �� JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V PRIVATE DISPOSAL SYSTEM C $ 3 00 ix CONNECT ADDITIONAL BLDG OR AFFIDAVIT WA 11 E� .!ZRT RECORD INSTR NO DATE O WORK TO HOUSE SEWER C $ 3 00 0 ALTER, REPAIR WABANDON HOUSE , W SEWER OR DISPOSAL SYSTFM C $ 3 00 OVERFU_O- 5" HWY ORST WIDENING a EXTN ,CESSPOOL, MANHOLE I< $ 5 00 hy STATE ENCROACHMENT 6 PERCOLATION TEST �} 0 $ 5 OG PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ i 00 CHARGES AUTHORIZATION I 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 INSPECT 'S SIGNATURE SIGNED THIS DAY OF 19_ — -� OWNER OR NEW HOUSE SEWER OWNERS CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP,PIT(S) I HEREBY CK OWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE HA THE ABOVE IS'CORRECT AND AGREE TO COMPLY WITH ALL O NTY ORDINANCES AND STATE LAWS REGULATING L A SEWERS CESSPOOL ❑ DRYWELL ❑ CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE D ISPOS AL SYSTEM OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND THE ABOVE DE RIBED RESIDENTIA PROPERTY ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS ❑ 1 ITTE SEEP PIT(S) Q CESSPOOLS ALIDATION CK M O CASH 5 5 5 sZS OCT 28 1 0 © 7:00Ncq