HomeMy Public PortalAbout8622 HALDEMAN ST_Sewer__ • 24650 INSERTS•
CE808 6.60 APPLICATI O FOR PERMIT '
,78A842D
COUNTY OF LOS ANGELES SEINER-S VIA DlSP0t AL .
' DEPARTMENT OF COUNTY ENGINEER Bu1LDING
BUILDING AND SAFETY DMSION -AD RE e-c
JOHNIA. LAMBIE, County En eer w
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEAREST a .,
FOR APPLICANT O FILL IN CROSS ST.
LEGAL ,OWN
DESCRIPTION LOT NO. _
BLOCK TRACT - 'MAIL
,ADDRESS
0 OF B GS. "
SIZE OF LOT NOW ON OT ,CITY TEL N0:
BUIUSOF,
LDINGS DISTRICT NO. -GROUP MAP PROCESSED BY
f BK PG
CONTRACTOR
�r
ADDRESS r CONNECTIO DATA' '
CITY - �. TEL.NO STATION %_l) DEPTH , - -
s
REGISTRATION NO. 7 STATE MANHOLE REFERENCE
COUNTY
NQ. V DESCRIPTION OF WORK FEE,
HOUSE SEWER CONNECTING TO '
PUBLIC SEWER @ $3.00 TYPE OF CONNECTI LENGTH FROM U ,
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L M.L.TO P.L.
ITS AND/OR DRAINFIELD C. $3 00
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.OR
WORK TO HOUSE,SEWER @ $1 00 TRUNK PERMIT N0. ROAD PERMIT NO., Q/�,
IR OR
NDON
ALTER,
DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT W
ER PERMIT NO _ O
INDUSTRIAL
WASTE APPROVAL W
CHARGES 7N
OWNERS PERMIT $ 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 6 REIMBURSEMENT FEE
1 HAVE AT•THIS DATE A CONTRACT WITH THE HEREYN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DqSCRIBED EXIING DWELLING, - APPROVALS •DATE_ INSPECTOR'S SIGNATURE,
TO THE PUBLIC SEWER, -
SIGNED THIS D 0 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL r
OWNERS AGENT BUILDING-OR.WORK,
ADDRESS SEPTIC TANK,SEEP PITS) "
AND/OR DRAINFIELD ,
I HEREBY A NOWLEDGE THAT 1HAVE READ THIS-APPLICATION• - - , - - --
AND STAT �T AT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL '
WITH A OUNTY ORDINANCES AND`STATE LAWS REGULATING ALTER,REPAIR,SEWER OR , -
PLUMBILA
ERS. - SEWAGE DISPOSAL SYSTEM
PLUM
Y THAT 1 AM PROPERLY R ISTERED AND/OR DISCONNECT PLUG AND
LICE S DIRED BY LOS A ES COU TY AND STATE OF. ABANDON HOUSE SEWERCAAT-' I AMTHE ABOVEDISC BETIAL PROPERTY J J BACKFILL SEPTIC TANKSSEEP. PITS) ❑ CESSPOOLSSIGNA ROF P RM
®� VALIDATIO ROBERT A. WOOD '
CK. m.o, cases SUPERVISING MECHANICAL ENGINEER
Leto 4. 8 8 ,6 Z�8. APR 41 A
r,