HomeMy Public PortalAbout8618 HALDEMAN ST_Sewer__ 24650 INSERTS"
-CE8D88.90 APPLICATION, FO PERMM,
78A842D COUNTY OF LOS ANGELES' SEWER--SMAGE ,DISPOSAL.. -
DEPARTMENT OF COUNTY ENGINEER
BUILDING
BUILDING AND SAFETY DIVISION JOHN A. LAMBIE. CouatY En eerWILLIAMA. JENSEN, Supt of Building Y-
FOR.APPLICANT TO FILL INr.
LEGAL OWNER
+ ,
DESCRIPTION LOT N0. - -
BLOCK TRACT MAIL _
'ADDRESS.
NO OF BLDGS. +
SIZE OF LOT NOW ON LOT •CITY TEL NO.
USE OF DISTRICT N0. GROU MAP ROCESS_ED BY
BUILDINGS 1- `rBK PG
CONTRACTOR
ADDRESS rL_ !!! CONNECTION DATA
CITY TEL.NO. STATION DEPTH
/ ATE ;MANHOLE REFERENCE 'S UPPER
REGISTRATION•N0. ,( COUNTY
No DESCRIPTION OF WORK tFEE
HOUSE SEWER'CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTIO LENGTH FROM '-
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00' '
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00 -
HOUSE SEWER CONNECTING TO P.C.NO. Z -
PRIVATE DISPOSAL SYSTEM @ $1 00 CO,IMP NO JOB NO.
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMITNO. ROAD PERMIT N0. Q
V
A"LTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO. p
INDUSTRIAL
WASTE APPROVAL W
CHARGES
OWNER'S PERMIT S •2 ,0}0-� CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE V, REIMBURSEMENT FEE
I HAVE,AT THIS DATE A CONTRACT ITH THEE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE SCRIBE EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY O 19_ NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL I
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY AC _OWLEDGE THAT 1 VE READ THIS APPLICATION - -
AND STATE 7 THE ABOVE 1S CO ECT-AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL UNTY ORDINANCES A STATE SLA REGULATING
PLUMBING D SEWERS. ` REPAIR,
SEWER SEWAGE DISPOSAL SYSTEM - +
'I
HER CERTIFY THAT 1 AM, ROPER RE STERED AND/OR DISCONNECT PLUG AND _
LICENSE ASo REQUIRED BY LOS A LE COLIN Y AND STATE OF ABANDON HOUSE SEWER -
CALIFOR A OR THAT I AM THE OWN R OF THE ABOVE
DESCRI DENTIAL PROPERTY. _ BACKFICL SEPTIC TANKS ❑ - - -
Q`�� SEEP.P,17(S) ElC
SIGNAT RESSP-OO LS 11e - `
OF PE
®P VALIDATION ROBERT A. WOOD
CE. - M.0. cnsa -SUPERVISING MECHANICAL-ENGINEER