HomeMy Public PortalAbout5566 HALLOWELL AVE_Sewer__ 24650 INSERTS
- CE8088-8D
76A842D APPLICATION FOR PER T
COUNTY OF LOS ANGELES SEWER-SEWAGE
WER-SESAiE DISPOSAL s
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE" County Engineer
WILLIAM A. JENSEN. Supt of Building LOCALITY
i -- NEAREST
FOR APPLICANT TO FILL IN CROSS ST. _ C
LEGALff// OWNER
DESCRIPTION LOT NO. 2L
BLOCK •TRACT MAIL r
ADDRESS
gg�� JJJO.OF BLDGS.
SIZE OF LOT C6 7'LNOW ON LOT CITY TEL. NO.
USE OF 1.N"M
BUILDINGS DISTRICT NO, GROUP MAP PRO ED BY
I BK PG I I
CONTRACTOR C.�
ADDRESS COzz
NECTION DATA
CITY EL.NO.
[ - STATION � DEPTH
v
" /' (� y STATE MANHOLE REFERENCE(/-
REGISTRATION NO. 6 J / COUNTY O a / LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBS CSEWER
@ $ 0
TYPE OF CONNECTIO LENGTH FROMSEPTIC TANK, /
ITS AND/ORDRAENFGELDT OR @ OO Y. CURB P.L. M.L.TO P.L. _
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ 2.00
HOUSE SEWER CONNECTING TO P.C.N0. _
PRIVATE DISPOSAL SYSTEM @\.00 CO. IMP. NO. JOB NO.
WORK C HOUSE ADDITIONALSEWELDG.OR - C.
00 TRUNK P MIT NO. ROAD PER V
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROAC T 94
SEWER OR DISPOSAL SYSTEM @ 1.00 PERMIT NO. O
INDUSTRIAL (j
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE " 9 REIMBURSEMENT FEE
' CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGDATE A CONTRACT WITH THE HEREINAMED DWELLIING APPROVALS AT� INSPECTOR'S SIG ATURE
TO THE PUBLIC SEWER. '
SIGNED THIS" DAY OF 19 NEW HOUSE SEWER
A
OWNER CONNECT ADDITIONAL U �'
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY 'ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
ANP STATE THAT' THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT 1 AM PROPERLY -REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LE L OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P PER_TY. BACKFILL SEPTIC TANKS ❑ `
SIGNATURE SEEP.PIT(S) ElCESSPOOLS [I
OF PERMITTE
Cr _ ALIDATION ROBERT A. WOOD
cK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
LACO2 AUG 610 0 7.00-