HomeMy Public PortalAbout5942 HART AVE_Sewer__ 76AS42D 4' PPUClrVTM N FOR Il E R tl V T .
canoe e•sa' COUNTY OF LOS ANGELES SEWER-SEWAGE DOSPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN neer
CASSATTAD.LGRRIIFFIN, Sup! of Building
LOCALITY
NEAREST
FOR APPLICANT -TO IN CROSS ST.
LEGAL f e
DESCRIPTION LOT N0.9
OWNER
MAIL
BLOCK TRACT ADDRESS
NO.OF BLDGS. e
-
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDIy DISTRICT N0
NGS . G�R7OU�P MAP OCESSED BY
CONTRACTOR o / I f- _— K 6e
PR
ADDRESS 2 -2 ' CONNNECTION DATA
CITY e ? TEL.NO a STATION DEPTH
A REGISTRATION NO. /G% COUNTY MANHOLE REFERENCE UP
PER
NO. DESCRIPTION OF WORK FEE OWER.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 ® TYPE OF CONNECTION LENGTH FROM A
SEPTIC TANK,SEEPAGE PIT OR CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
'F OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO I ?? P.C.N0. _
PRIVATE DISPOSAL SYSTEM @ $1:00 C0:IMP. N0. O JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
_
SEWER OR DISPOSAL SYSTEM IR OR ABANDON HOUSE ' STATE ENCROACHMENT
@ $I 00
PERMIT NO.
n_ INDUSTRIAL
_ WASTE APPROVAL
� CHARGES
OVMER'S PERMT S 2 00 CONNECTION'CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE1HAVE AT THIS DATE A CONTRACT WITH THE
NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIISTIING DWELLING APPROVALS DATE. INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWa /
SIGNED THISDAY OF 191 NEW HOUSE SEWER
OWNER OR g CONNECT ADDITIONAL
OWNERS AGEDN' `• - BUILDING OR WORK
ADDRESSdo
SEPTIC TANK,SEEP.PIT(S)
_ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND 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
1 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 I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PR,0PE " BACKFILL SEPTIC TANKS
7 SIGNATURE
SEEP. PIT(S)
❑ CESSPOOLS
OF PERMITTEE
®" ALIDATION ROBERT A. WOOD
cK. M.Q. CASH SUPERVISING MECHANICAL ENGINEER
z t 6 6 0� 'FLB 0 A Jam_ . :_