HomeMy Public PortalAbout5921 HART AVE_Sewer__ a E,-6D
S - APPL��tJ.//"11T�®IlV FOR PEI7l1HVB 0
S&E-863 11.55
DIVISION OF BUILDING-AND SAFETY SEWER—SEWAGE .D 9 S POSH L
' Department of County Engineer ,,r„,,.T �; •._.,;- s
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS .
® CASSATT D. GRIFFIN, SUP'T OF BUILDING '
LOCALITY
i7 7-IF77r,
FOR APPLICANT TO FILL IN CROSS sr.
LEGAL
DESCRIPTION LOT.N0. OWNER /a. /
ot
BLOCKMAIL- TRACT `Q ADDRESS '
WOF.BL GS. /� CITY TEL. N0.
SIZE OF LOT N LOTUSE OF
BUILDINGS Z/..%t.�`� 47 (DIST ICT NO. GROUP•" MAP
BK PG
CONTRACTOR
loll CONNECTION DATA
ADDRESS -
STATION .� DEPTH
CITY TEL. NO. MANHOLE REFERENCE PPER '
STATE
REGISTRATION NO. � � ❑ COUNTY 9
NO. DESCRIPTION OF-WORK FEt TYPE.o TION LENGTH FROM
HOUSE SEWER CONNECTING TO /,, Y. CUR P.L. M.L.TO P.L. tp
J PUBLIC SEWER @.$3.50' 0 -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00 '
OVERFLOW SEEPAGE PIT, DRAINFIELD i �r� P. C.
EXTN.;CESSPOOL,DRYW ELL,MAN HOLE Q $2.00 CO. IMP. N0. �. J06 NO.
'
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK P RMIT NO. -ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR z STATE EN OACHMENT
WORK TO HOUSE.SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM- Q. $1.00 WASTE APPROVAL '
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT $ 1 00 REIMBURSEMENT FEE ,-�'i
AUTHORIZATION TOTAL FEE —�
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- e. APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE Df4,CRIBED EXISTING DWELLING -
- TO THE PUBLIC SEW NEW HOUSE SEWER• .- i
SIGNED THISDAYCONNECTADDITIONAL
O 9
OWNER OR BUILDING OR WORK - -
OWNERS;''AGENT SEPTIC TANK,SEEP,'PIT(S) '
ADDRESS AND/OR DRAINFIELD - -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS R£GUL . G ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGIS D AND/ORDISCONNECT PLUG AND -
LICENSED AS REQUIRED BY LOS ANGELES. UN AND STATE OF 't'' ABANDON HOUSE SEWER -
CALIFORNIA OR THAT THE LEG R E ABO
DESCRIBED RESIDENT - ROPERTY. BACKFILL SEPTIC TANKS❑ ' / a- n,,,1��� •'
SIGNATURE - SEEP. PIT(S) [ICESSPOOLSOF PERMITT ' v -• vV
JOHN A. LAMBIE. TY ENGINEER IDATIn.AS. ROBERT A. WOOD, CIiIEF PLBG. INSPECTOR
M.O.� -