Loading...
HomeMy Public PortalAbout6266 GOLDEN WEST AVE_Sewer__ 769644ii;. 1!-10-71 APPLICATION FOR PERMIT COUNTY OF L08 ANGELES SEWER-SEWAGE DISPOSAL bEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Mr—TYT—eol" Q 16leTfFOR APPLICANT TO FILL IN V / / D E/CRIFTION LOT NO. `� [ OWNER O/`/J 14,z— MAIL BLOCK TRACT ADDR1340040 v NO. OF 11L.1009. SIZE OF LOT NQW ON LOT I CCT' TEL NO. U•[ OF /c `! DIDTRICT NO. •ROUP MAF SEDJBY ■U ILDINOS fV(J C cc A EE FJ QONTTIACTOR N O TIS T� O ,DJ'QJ / D ` V f� 7/ ADDRESS pqvs Piz -'/ /-�CCOPMCnON DATA CITY I� �-{/ T'[L. NO. — / STATION �.L J-!� DEPTH `IGEN.•[ NOS [TWO `L Z Lb AN I3 I MANHOLE REF[7RE�H/C�[J/ I ` � -R Nb. PF-SCRIPTION OF WORK FEE TYPE OF c& ION LrMGT FROM HOUSE SEWER CONNECTING TO o Y. ■ P.L M.L.TO P.L PUBLIC/[woe ! $7.00 • FTIC TANK.sffpAoK PfT OR P.C.NO. O. CO.IMP.NO. JO■N FIT/AND/OR DRAINFICLD ! 510.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT No. ROAD PERMIT NO. PRIVATE DISPOSAL■YUTEM ! S3.00 O CONNECT ADDITIONAL■ R AFFIDAVIT t mvLa [I1[ST RECORD.IN•TR.NO. DATE L) WORK TO HOU;[BEW" ! 57.00 OVERFLOW/[[PAG[PIT.DRAINFIKLD E)CTN..CE/SPOOL.DRYWELL ! [6.00 O AL .R A ABANDO HOUSE HWM. OR ST.WIDENING •[W[R OR DIBPOSAL SYSTEM ! 3.00 STAT[ENCROACHMENT MANHOLE PERMIT NO. a ! X7.00 [/) IN DueTRIAL Z ���7�� WAST[APPROVAL O nl\L.il PEBDQC j 3100 CHARGES CONNECTION CHARD[F[[ AIITHOffiZATION TOTAL r 1 HAVE AT THI; DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT�[E TRACTOR TO CONNECT THE ABOVE DE■CRIBXD TO THE PUBLIC /[W�fy APPEOVAIS DAT[ INS R'■SI TUR[ SIGNED THIS (( DAY OF tfl7) �( OWNER OR KEW HOUSE/[WEA V OWNER/AGENT CONNECT ADDITION WILDING OR WORK SEPTICADDR[Se I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR TANK.BEEP,PIT(e) AND�OR QRAINFI[LD AND BTAT[ THAT TH[ AeQVE is CORRECT AND ACRE[ TO COMPLY WITH ALL COUNTY ORDINANCES AND /TATE LAWS REGULATING PLU Me ING AND BEWERB. CUMPOOL ❑ -WELL ❑ I HERESY CERTIFY THAT 1 AM PRO"RLY REGIST[ [ ERW RD AND/OR ALT .REPAIR.SEER OR LICENSED A& REQUIRED ■Y LO■ ANGLES CQUNTY AND STATE OF SEWAGE DISPORAL BYST[M CALIFORNIA OR TH M TH[ LEGAL OW N[R F, AND NO TO DISCONNECT PLUG AND ' RESIDE IN, TH OV[ [SG IB<D R [NTS AeANPON HOUSE■EWER BIO NATURE BACKFILL SEP7BC TANKS ❑ OF P[RM u ...P.IF cEB;Poou VALIDATION CK. M.0. CASH 1i 060973 APR1710 D 10e04