HomeMy Public PortalAbout6156 HART AVE_Sewer__ - kPPLICAT'104
S&E-663 3.55 R11 V Ufl1DIVISION OF BUILDING AND SAFETY rOR
IlV-SEWER-SEN AGE D I S POSA L
Department of County Engineer `' z
County of LOS Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER _ADDRESS
® CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY .� a
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL A
DESCRIPTION LOT N0. OWNER GCd6✓ G
BLOCK TRACT MAIL
ADDRESS
SIZE OF LOT g&l NO. OF BL ,ted
NOW ON LOT
CITY TEL. NO.
USE OF0
BUILDINGS DISTRICT GROUP BK MAP
CONTRACTOR ,d I I � /— .
ADDRESS ,f. CONNECTION DATA
REGISTRATION NO. 1CITY , Co- TEL. N0. STATION r�.¢.�O a DEPTHy
�f0 5 COUNTY MANHOLE REFERENCE l� �] OWER
NO. DESCRIPTION OF WORK FEE TYPE.A' VECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. ( CUR6 J P.L. M.L. TO P.L.
PUBLIC SEWER Q $ 3.50 1
HOUSE SEWER CONNECTING TO
PRIVATE'DISPOSAL SYSTEM 1.00
CONNECT ADDI TIONAL BLDG. OR �, n�y� P. C..NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. .,..0 JC JOB N0.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 - TRUNK PERMIT N0. ROAD PERMIT N0. lJ�
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT -
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE-PIT OR ^�
PITS AND/OR DRAINFIELD a.00 INDUSTRIAL
CESSPOOL- DRYWELL - WASTE APPROVAL
SPECIAL CONDITIONS ONLY' 2.00 CHARGES
CONVECTION CHARGE FEE
OWNERS PERMIT S t 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEEp�(
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SE4 ER®
SIGNED THIS DAY 0- A 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AG NT BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS , AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[3DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT' 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED BY LOS ANGELES-COU TY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM THE LEGAL 0 ER OF THE BOVE ABANDON HOUSE SEWER .
DESCRIBED RESIDENTIAL ROPERTY. BACKFILL SEPTIC TANKS Cl
SEEP. PIT(S) ❑ CESSPOOLS'❑
SIGNATURE
OF PERMITTEE.
WILLIAM J.FOX, COUftfY ENGINEER VALII)4TION R.A.WOOD, CHIEF PLBG. INSPECTOR
To 8 7 2 JUL 3:� '-� 4.5 – L�