HomeMy Public PortalAbout8615 HALDEMAN ST_Sewer__ 24650 INSERTS p T
claoae.so APPLICATION,, FOR PERM 1
:�eAeazu COUNTY OF LOS ANGELES SEWED—SEA AGE l,SPOSAL•
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS',
JOHN A. LAMBIE, CouatY Engineez /+
ux
WILLIAM A JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN 'CROSSov
LEAL
s .
DESCRIPTION LOT NO. OWNER- t
BLOCK ` TRACT •MAIL
r .,MAIL
�.I •+, ti
NO OF BLA5GS. - - -
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE
BUILDINGS DISTRICT NO. GROUP MAP- PR ESS BY
'
BK PG
CONTRACTOR -
ADDRESS 1.� - CONNECTIO ' DATA r
CITYTEL NO. ' ATION � , DEPTH
STATE MANHOLE MANHOLE REFERENCE - - P
REGISTRATION NO. LJ COUNTY 42 711). -ALumm
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 'TYPE OF CONNECTI0 - LENGTH FROM
PITS AND/OR DRASEPTIC TANK, ENFIELDT OR @ $3 00 Y. - CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT NO. ROAD PERMIT NO. Q
WORK TO HOUSE SEWER @ si DO U
SEWER OR PAIRO R ABANDON
SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT - ca
PERMIT NO p
INDUSTRIAL F
.WASTE APPROVAL W
CHARGES y
CONNECTION CHARGE FEE
OWNERS PERMIT $' " 2 •00 -
AUTHORMATION TOTAL FEE REIMBURSEMENT FEE _
I 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 SEWER. ,.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER l
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD '
C HEREBY ACKNOWLEDGE THAT 1 HAVE,READ THIS -APPLICATION •• • '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ '
WITH ALL COUNTY
ORDINA CE_S AND,STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM l
1 HEREBY CERTIFY 1 AM PROPERLY REGISTER AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIR Y LOS ANGE ES COUNTY AN STATE OF -ABANDON HOUSE SEWER - -
CALIFORNIA OR. TH AM THE LE WNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESID ROPERTY, v SEEP PIT(S) El CESSPOOLS [I_..
SIGNATURE
OF PERMITTE
OF VAUDATION- , ROBERT A. WOOD
CIL Y.o. CASR/J SUPERVISING MECHANICAL ENGINEER,
C