HomeMy Public PortalAbout6137 GOLDEN WEST AVE_Sewer__ i
J
f
76Jc4ED APPLICATION FOR PERMIT' .
CEBC6 6.88 � Y
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL i■
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
IOfiN A. LAMBIE, County Engineer
CASXT D. GRIFFIN. Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT ADDRESSel" ��/ �j •.Gt. HCl
n q NO.OF BLDGS.
SIZE OF LOT V y NOW ON LOT CITY 902&1TEL. NO. V'•�V IC
USE OF r ® DISTRICT N0. GROUP MAP 'PROCESSED BY
BUILDINGSC�L ..+-
1 I BK PG I
CONTRACTORdo
_11
11111
ADDRESS36 - CONNECTION DATA
Z.
CITY TEL.NO. 6/ STATION DEPTH
STATE ,MANHOLE RefEaENCE UPPER
REGISTRATION NO. !� 2 ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 YPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR YsJTCURB P.L. M.L.TO P.L.
ITS AND/ORDRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 - CO. IMP. NO. 1332- JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
' INDUSTRIAL
WASTE APPROVAL
CHARGES
0VVI ER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHOPMATION TOTAL FEE i < REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWEFj.
SIGNED THIS J� DAY OF 1 �' 194610 NEW HOUSE SEWER
OWNER OR r CONNECT ADDITIONAL
OWNERS AGENT // BUILDING OR WORK
ADDRESS �� �I7 ��' f�/rkA'�' l� ASEPTIC ND/OR TANK,
SEELDPIT(S)
DRAI1 HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROP TX. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERM ITTEELO.4�21
OF ALIDATION ROBERT A. WOOD
CX.
M.0. CASH SUPERVISING MECHANICAL ENGINEER
_. IP,0 7 7 2 2 o PAR 15 0 A 5.00