HomeMy Public PortalAbout8629 HALDEMAN ST_Sewer__ -24650 INSERTS, _
7E0086.e0.
7epe42n APPLICATION -FOR PERMIT •
COUNTY OF LOS ANGELES SEWER—SEWAGE ISPOSAL, _
-I
DEPARTMENT OF COUNTY'ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS c•f
IOHN A..LAMBIE; County Engineer
WILLLRM A. JENSEN, Supt of Building LOCALITY
NEAREST '
FORK APPLICANT;0 FILL IN CROSS sT. '
LEGAL OWNER''.
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
0 OF BLDGS.
SIZE OF LOT ,NOW ON LOT 'CITY TEL NO _USE OF _ DISTRICT N0. GROUP MAPG
,D BY
BUILDINGS / �BK A PG P
CONTRACTO , - �'
ADDRESS , CONNECTION DATA
CITY TEL NO. �¢ STATION DEPTH •-
• ❑ STATE MANHOLE REFERENCE
REGISTRATION NO. ❑.'COUNTY '
NO DESCRIPTION OF VfORK F
HOUSE SEWER CONNECTING TO f}j') "
PUBLIC SEWER @ $3 00 V ''��'' TYPE OF CONNECTI LENGTH FRO ' / v
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 TOP.C..NO.
PRIVATE DISPOSAL SYSTEM `@ S1 00 CO IMP. NO. JOB NO. �J
CONNECT ADDITIONAL BLDG.,ORTRUNK PERMIT N0. ROAD PERMIT N0. Q
WORK TO HOUSE SEWER @ $1 00 '` 0
SEWER OR DASPIR OR ABANDON SAL YSTEM HOUSE @ $1 00 ,STATE ENCROACHMENT
,PERMIT NO. 0
INDUSTRIAL - - V
WASTE APPROVAL W _
CHARGES N
OWNER'S PERMIT $ 2 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 DESCRIBED EXISTING DWELLING ' 'APPROVALS_ DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DA O� 19� NEW HOUSE SEWER r
OWNER OR CONNECT ADDITIONAL '
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS APPLICATION - - •.- - - - ••_
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL-0 DRYWELL ❑ '{
WITH ALL COUNTY RDINANCES AND STATE LAWS REGULATING pLTER,.REPAIR,SEWER OR
PLUMBING ANDS RS. SEWAGE DISPOSAL SYSTEM
I HEREBY CE IFY THAT I AM PROPERLY REGISTERED.AND/OR DISCONNECT PLUG AND e —
LICENSED A EQUIRED BY.LOS ANGELES COU TY AND STATE OF ABANDON HOUSE SEWER - '
CALIFORNI R THAT I AM LEGAL' W R OF THE ABOVE
DESCRIB ENTIAL PROPERTY BACKFI LL SEPTIC TANKS ❑ ,
SIGNAT E ' G` SEEP. PIT(S) ❑ CESSPOOLS.❑ t '
OF PE
OF VALIDATION ROBERT A. WOOD
` CK., M.o, cesR SUPERVISING MECHANICAL ENGINEER,
4� 1 5.00 .