HomeMy Public PortalAbout4831 HALLOWELL AVE_Sewer__ L
76A642 -61 APPLICA ON FOR � RMIT
76A 642D �''°°'' f�'
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
MB
JOHN A, LAIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building_ LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT N0. OWNER
BLOCK TRACT NAIL
ADDRESS G
140.0E GS.
SIZE OF LOT NOW ON LOT CITY t14 'TEL. NO
USE OFDI ^ - �+ DISTRICT NO. GROUP AP 7Pt0UF7,SSED Y
BUILDINGS - � �Cl�-_- PQ.
CONTRACT
ADDRESS CONNECTION DATA
CITY TEL.NOSTATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO., `0 COUNTY / LOWER
NO. 1 DESCRIPTION OF WORK FEE
PUBLIC SEWER CONNECTING TO @ $1.00
TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ f 1.00
OVERFLOW SEEPAGE PIT.DRAINFIELD >_
EXTN..CESSPOOL.DRYWELL @ S:.00 d
HOUSE SEER PRIVATE DISPOSAL SYSTEM TO @ f 00 CO.IMP. NO. JOB NO. VO
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0. Ix
WORK TO HOUSE SEWER f 00
ALTER,REPAIR O R ASYSTEN HOUSE @ f 00 STATE ENCROACHMENT _ 0
PERMIT NO. W
INDUSTRIAL a.
WASTE APPROVAL N
CHARGES ?
OWNER'S PERMM $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A.CONTRACT WITH THE HEREIN N ED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ATE) INSPECTOR'S SIGN T RE
TO THE PUBLIC SEWER,
SIGNED THIS DAY 0 J9— NEW-HOUSE SEWER
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 STATETHAT T OV
E IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRY-WELL
WITH ALL COU OR NANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING A SEWER . SEWAGE DISPOSAL SYSTENI
1 HER"ERTIHAT 1 AM- PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSEBY-LOS ANGELES COUNTY, D STATE OFABANDON HOUSE SEWER
CALIFORI AM THE'LEGAL OW ER THE ABOVE
DESCRIBL ROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATU SEM PITS CESSPOOLS OF PERMITTE
VALIDATION ROBERT A. WOOD
cK. U.o. _ CASx SUPERVISING MECHANICAL ENGINEER
0964 AFR12 1 O 'D '7.00