HomeMy Public PortalAbout6303 GOLDEN WEST AVE_Sewer__ E-6D
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APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer 'y 7
County of Los Angeles BUILDDDREING
ADDRESG „3�/ 3
JOHN A. LAMBIE, COUNTY ENGINEER
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CAS SATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY `•
FOR APPLICANT T FILL
LEGAL " OWNER
DESCRIPTIO LOT N0. ,,fs�•s"^--
BLOCK TRACT MAIL (•p.;3 0 3
ADDRESS
t
N 'OF DGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK p
CONTRACTOR � �f /
!h ILL�i��r�FFFi /
ADDRESS r/ 5. 77 CONNECTION DATA a -
STATION SI DEPTH
CITY TEL. NO. MANHOLE REFERENCE Q UP
REGISTRATION NO. / �` y y ❑ STACOUNTY WER
NO. DESCRIPTION OF WORK FtE
HOUSE SEWER CONNECTING TO TYPE OF BION LENGTH FROM S
PUBLIC SEWER $3.50 .33 - _Y• CURB P.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO., 1
i EXTN.,CESSPOOL,DRYWELL,M AN HO LE Q $2.00 0B NO
I HOUSE SEWER CONNECTING TO /]
I PRIVATE DISPOSAL SYSTEM Q $1.00 iRUN_K_PERMIT NO. ROAD PERMIT NO. -7
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER STA TE ENCROACHMENT
Q $1.00 PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE J G✓' �`
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 /D /
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR /i2_/�J BUILDING WORK
__
OWNERS AGENT :/r� �1 re� �`��'' SEPTIC—TANK,SEEP,PIT(5)
ADDRESS 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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
ABANDON HO PLUG PLUGUSE AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE —
DESCRIBED RESIDENT L PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE ❑ i
SEEP.PIT(S) LlCESSPOOLS ;
----
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M. 0. CASH
3 5 2 4 1 OCT 18 4 5.5 0 0