HomeMy Public PortalAbout8612 HALDEMAN ST_Sewer__ 24650 INSERTS,
76A642D - APPLICATION, FOR PERM-IT,EwIT :�-_ � ,t•• 4
`COUNTY OF LOS ANGELES SEWER=SEWAGE ,DISP®SAL.
DEPARTMENT OF`COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
"_JOHN A.,LAMBIE, C.= En neer ;
Wi
LLIAM A. JENSEN, Supt of Building LOCALITY i
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL'
DESCRIPTION - LOT NO - 'OWNER /�-
BLOCK -TRACT •MAIL _
ADDRESS
_ NO OF BLDGS. �'" -
SIZE OF LOT NOW ON LOT CITY 21 _TEL NO. ' '
USE OF DISTRICT NOGROUP MAP PROCESSED BY
BUILDINGS BK! PG _ V
CONTRACTO �.
ADDRESS CONNECTION DATA
CITY TEL NO. ATION D DEPTH
A MANHOLE REFERENCE UPPER--,
REGISTRATION NO. COUNTY
NO. DESCRIPTION OF WORK V FEE
HOUSE SEWER CONNECTING TOi4•C� -
PUBLIC SEWER ^ @ $3 00 TYPE OF CONNECTION .L. M.L.
TO P.L.
LENGTH FROM
PTS AND/OR DRASEPTIC TANK INFIELD PAGET OR$ 3 00 Y. ' CURB (.-�
OVERFLOW SEEPAGE PIT,DRAINFIELD < '
EXTN CESSPOOL DRYWELL @ $2 00 '
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 SCO IMP-NO., JOB NO.
CONNECT ADDITIONAL BLDG.OR, TRUNK PERMIT NO. ROAD PERMIT N0. p
WORK TO HOUSE SEWER @ $1 00 U
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO.
INDUSTRIAL ,
WASTE APPROVAL 1
CHARGES P.
OWNER'S PERMIT $ 2 X00/7 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE (J (/ REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT-WITH THE HEREIN NAMED CON- _
TRACTOR TO CONNECT THE ABOVE ESCRIBED E (STING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS D Y 19= NEW'HOUSE SEWER ®T
T •NCE?
OWNER OR, CONNECT ADDITIONAL
OWNERS AGENT BUILDING•OR WORK
ADDRESS -SEPTIC TANK,SEEP PIT(S) • -
AND/OR DRAINFIELD
1 HEREBY - CKNOWLEDGE THAT. I HAVE READ THIS <APPLICATION
AND STATE HAT THE ABOVE IS CORRE AND-AGR TO COMPLY CESSPOOL ElDRYWELL El
WITH 'A COUNTY ORDINANCES AND TATE LAW REGULATING ALTER,REPAIR,SEWER OR
PLUMB( NO SEWERS. - SEWAGE DISPOSAL SYSTEM
1 HERE CERTIFY THAT V AM' PR P LY E STEREO AND/OR DISCONNECT PLUG AND
LICENSE AS REQUIRED_ BY LOS ANG LES N AND STATE OF ABANDON HOUSE SEWER-
CALIFOR A OR THAT I AM THE L A- OW THE ABOVE'
DESCRIB R DENTIAL PROPS Y. BAC C TANKS ❑ ,
SIGNATU E a (GGIXKC��� PIT(S) El CESSPOOLS [3
OF PER IT
OF VALIDATION--) ROBERT A. WOOD-
CIL X.o.- CASH j SUPERVISING MECHANICAL ENGINEER