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HomeMy Public PortalAbout6023 GOLDEN WEST AVE_Sewer__ APPLICATION FOR 8&E-883 i..59 IT DIVISION`OF' BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL . Deportment of County Engineer County of Los Angeles BUILDING je l� JOHN A LAMBIE, COUNTY ENGINEER ADDRESS q { - / e.5� ® CASSATT D. GRIFFIN, SUP•roFBUILDING LOCALITY FOR APPLICANT TO FII.I. IN I CRS sr. LEGAL - C k'-U�„ �j'� OWNER171 �p.�q(,fes DESCRIPTION LOT NO �j ,Q LL_� I , �3 , �j/�•�'e�j•�� MAIL BLOCK - TRACT �. ADDRESS 6 / de*I 6KJt SIZE OF LOT-50 � �D� N0. OF BLDGS. -7 � CITY T ,(� CL` TEL. NO. 6•� � � , NOW ON LOT /-� USE OF I BUILDI ,E ����/( '7" d DISTRICT NO. _ GROUP MAP NGS yL/.,/ BK PG CONTRACTOR -�� CONNECTION DATA ADDRESS aT� 5 rwSTATION DEPTH - CITY TEL, NO. © cC L ��, MANHOLE REFERENCE UPPER 3 ❑ STATE LOWER REGISTRATION NO e ❑ COUNTY NO. DESCRIPTION OF WORK FE (� HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3 50 Y. CURB P.L M.L.TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT, DRAINFIELD CO IMP N0. l,3 6 JOB NO. EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 d PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL - - CHARGES CONNECTION CHARGE FEE OWNERS PERMIT $ - 00 REIMBURSEMENT FEE _ G�UCJC AUTHORIZATION TOTAL FEE 0 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 JQ,,J�(y NEW-HOUSE SEWER' �Z SIGNED THIS `°L DAY OF ^�y J L4 19L '+ CONNECT ADDITIONAL ` OWNER OR Y BUILDING OR WORK_ OWNERS AGENT ^ /'�� SEPTIC TANK,SEEP, PIT(S) - ADDRESS 62�' G, o dB k AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR - PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED 'AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS 'ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW CALIFORNIA OR THAT I AM THE LEGAL' OWNER OF THE ABOVE ER DESCRIBED RESIDENT AL ROPERTY - BACKFILL SEPTIC TANKS❑ �'�y' , SIGNATURE SEEP PIT(S) ❑ CESSPOOLS OF PERMITTEE - JOHN A LAM IE, COUNTY ENGINEER VALIDAT ROBERT A WOOD, CHIEF_PLBG INSPECTOR ' CK d 0 LASH 3 09 JUL23-1' A -2 00