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HomeMy Public PortalAbout6003 HART AVE_Sewer__ D 5&E-669 11.55 APPLICATION FOR PERMIT 1 S&E•6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of LOS Angeles BUILDING O JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING -- LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS SL i LEGAL DESCRIPTION LOT NO. y ' �y�, .;. t �Jf� _OWNER �I 1AI BLOCK TRACT MAIL ADDRESS NO. OF BLDGS. CITY TEL. NO. SIZE OF LOT NOW ON LOT USE OF DISTRICT NO. GROUP MAP BUILDINGS ////^����� V�j�/N /� _ > BK PG CONTRACTOR �f/y I rj,2I C I ADDRESS L-Y /`t V 1 A AlYi,7—A ^ CONNECTION DATA CITY A TEL.R N0. -7/ �•. ! / (,y/r 7� STATION -2 - DEPTH l f MANHOLE REFERENCE - STATE REGISTRATION NO. ! L/ ❑ ' °ti._ LOWER ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CC'NkECTION LENGTH FROM PUBLIC SEWER Q $3.50 Y• CURB P.L. M.L. TO P.L. ' --ff-- SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELDP. C. NO I EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. NO. le} ��^ � JOB NO. i HOUSE SEWER CONNECTING TO I PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER Q $1.00 ""' PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM « $1.00 INDUSTRIAL E ` _ WASTE APPROVAL f CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT g 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE ; I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC WE NEW HOUSE SEWER SIGNED THIS DAY OF ¢"t` 19S CONNECT ADDITIONAL OWNER OR v © BUILDING OR WORK OWNERS AGENT res+���JZ.4 SEPTIC TANK,SEEP,PIT(S) LDRES AND/OR DRAINFIELD EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - _._.. LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR NG AND SEWERS. SEWAGE DISPOSAL SYSTEM EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECTPLUG AND ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFABANDON HOUSE SEWER RNIA OR.THAT I AM THE LEGAL OWNER OF THE ABOVE ED RESIDENTIAL PROPER Y. BACKFILL SEPTIC TANKSURE SEEP. PIT(S) ❑ CESSPOOLRMITTEE JOHN A. LAMBIE• COUNTY ENGINEER ]VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CKj N. O. CASH �O4 6 1 81,E 10v26 4 5 .50 0