HomeMy Public PortalAbout8628 HALDEMAN ST_Sewer__ r
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.76A642D60
A PLICATION, FOR PERMIT , -
COUNTY OF LOS ANGELES SEWER-SEWA DISPOSAL. : :
DEPARTMENT OF COUNTY ENGINEER TAILDING
"BUILDING AND SAFETY DIVISION DE)OHN A. LAMBIE, County EngineerWILLIAM A. JENSEN, Sup't of Building CALITY'ARESTFOR APPLICANT O IN OSS ST,
LEGAL
.DESCRIPTION LOT NO. .OWNER r4 rz : _ -
BLOCK- TRACT O MAIL
`�- ADDRESS -
_ NO OF BLDGS. - -
SIZE OF LOT "NOW ON'LOT CITY .TEL. NO.
USE OF �
BUILDINGS DISTRICT N0. GROUP MAP P CES ED BY
�BK PG
CONTRACTOR n• �� -
ADDRESS j/ CONNErTTON DATA
CITY TEL.NO. 'STATION13
DEPTH '
STATE :MANHOLE REFERENCE - UPPER
REGISTRATION NO. COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE.SEWER CONNECTING TO
PUBLIC SEWER� @ $3.00 TYPE OF CONNECTIOP.L. LENGTH FRO U,
SEPTIC TANK,SEEPAGE PIT OR Y. CURB M.-L.TO P.L. _3 d'
PITS AND/OR DRAINFIELD @ $3.00 _
OVERFLOW SEEPAGE PIT, DRAINFIELD'
EX TN. CESSPOOL. DRYWELL Co') $2 00
HOUSE SEWER CONNECTING TO CO.IMP. NOJ C.OB NO. f
PRIVATE DISPOSAL SYSTEM @ $1.00 .
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. _ ROAD PERMIT NO. 0-
WORK TO HOUSE SEWER @ $1 00 U ,
SEWER OR DIIR OR ABANDON SPO AL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT 1y
PERMIT NO. 0
INDUSTRIAL E"
^WASTE APPROVAL W
CHARGES
OVMER•.S PERMIT $ "21 00 CONNECTION CHARGE FEE ,
AUTHORIZATION ' TOTAL FEE REIMBURSEMENT FEE ,
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED,CON-
TRACTOR TO CONNECT THE ABOVE)'DESCRI ED EXISTING DWELLING -APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. ,
SIGNED THIS DAV F. 9- NEW HOUSE SEWER -� n�'
OWNER OR .CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK - -
ADDRESS SEPTIC TANK,SEEP.PITS) '
AND/OR DRAINFIELD
1 HEREBY ACK LEDGE THAT•I HAVE READ THIS APPLICATION
AND STATE THAT WTHE ABOVE IS CORRECT AND/AREE TO COMPLY CESSPOOL ❑ DRYWELL ❑^
WITHALLCO TY;ORDINANCES AND STATE, WS- REGULATING ALTER,REPAIR,'SEWER OR
PLUMBING AN EWERS.' - SEWAGE DISPOSAL SYSTEM1HEREBY TIFY THAT f AM PROPERLY RSTERED AND/OR DISCONNECT PLUG AND '
LICENSED AS: QUIRED_ BY LOS,ANGE S• COU TY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA THAT I AM THE L L OW ER OF THE ABOVE BACKFI,LL'SEPTIC TANKS ❑ "
DESCRIBED R S IAL PROPERTY.
SIGNATURE SEEP.PIT S) ❑ CESSPOOLS _ -
OF PERMITT ,
®P VALIDAnoOl ' ROBERT A. WOOD _
-c1L N.O., CASH// SUPERVISING MECHANICAL ENGINEER,-
4 8
NGINEER"4 '8 8Pr 4 �. 5:0 .