HomeMy Public PortalAbout10808 GRAND AVE_Sewer__ 71
'6A°A" APPLICATION FOR PERMIT 1
• eaDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
D.pa rh-nt of Cott EnQhum
C=2tr of Los Angeles FADDRESS
DING
JOHN A. LAMBIE, CbuNTY ENGINIKER
m CASSATT D. GRIFFIN, 8UP'T of BUILDING LITT
NW
FOR APPLICANT TO FILL IN aT
LKG�,L OWNER
DHSCli1Mon LOT N0.
RAIL 20
BLOCK TRACT ADDRESS
NO.OF BLDGS. ,
SRH OF LOT .NOT ON LOT CITY TEL NO I
BUILDINGS
DI DL4TRICT N0. GROUP RAP
BUILDINGS � _
BC PG
CONTRACTOR J�- � l/5 `
ADDRESS �' w r CONNECTION DATA -
CITY TEL NO STATION DEPTH >
MANHOLE REFIAEI[C8
'TT-STATE d OWER
REGISTRATION NO. ❑ COUNTY _
NO. DESCRIPTIO OF ORK FEE
HOUSE SEWER CONNECTING TO Ir TYPE OF CONNECTION LENGTH FROM
PUBLIC STEER !8 3.50 '� Y. CURB P.L. Y.L.TO P.L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® 4 9.00
OVERFLOW SEEPAGE FIT,DRAINFIELD P, C. NO. - -
EKTN.,CEBSPOOL DRYWELL MANHOLE $2.00 CO. IRP. N0. JOB n0.
HOUSE SEWER CONNECTING 0 y
PRIVATE DISPOSAL SYSTEM B 41.00 TRUNK PERMIT NO. ROAD PERMIT NO. (J
CONNECT ADDITIONAL BLDG.OR STATE ENC26ACHUHAT
WORK TO HOUSE SEWER s 1.00 PERMIT NO.
ALTER,R AIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 1.00 WASTE APPROVAL
GUAR G ES
CONNECTION CHARGE FEE
OVP arsPERMIT s 1 00
AUTHORIZATION TQTAL FEE REIRBURnMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN HAYED CON- AOVAI'S DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING IMG
TO THE PUBLIC SEWER. NEW HOUSE SEWER - !�. /• -
SIGNED THIS----,.— OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING 02 WORK
PWNERS AGER SEPTIC TANK,SEEP,PIT(S)
ADD ES AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH A{L COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG END
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSES ER
CALIFORNIA OR THAT I A ,THE LEGAL 0 ER OF THE ABOVE
DESCRIBED RESIDENTIAL P ERTY. BA KFILL SEPTIC TAX KS
❑
SIGNATURE SEEP. PIT(s) El CESSPOOL!
OF PERMITTEE
JOHN A. LAMBIE, Co TY ENGINEER ALIDATTON ROBERT A. WOOD, CHIEF PI-130. INSPECTOR
3°7 a z� .DEC 31 4. 4.5 0 , in