HomeMy Public PortalAbout6233 HART AVE_Sewer__ CE808 8-88 '
COUNTY OF LOS ANGELES SEWER—SE AdE DUSPOS L
DEPARTMENT OF COUNTY ENGINEER � pp
BUILDING AND SAFETY DIVISION ADDRESS- ({i 3 (o Z 3E 1`YA-$
JOHN.A. LAMBIE,. County Engineer
CASSATT D..GRIFFIN, Sup't of Building LOCALITY
:_•. .=;:.. 43.• NEAREST. .4
CROSS ST /�• �;
FOR APPLICANT ATO FILL IN
LEGAL
DESCRIPTION LOT NO.RC), T,? iD� d�O oh / OWNER �)4'q
L9MAIL
BLOCK TRACT ADDRESS G� i�e ..%••
0.OF BLDGS. J v7
SIZE OF LOT1,91j-111NW ON LOT CITY -C -TEL.-N0. I'— /5'0 c LS -
1USE OF �J yam- ,!' / - _ ,,,.-.o ,r.,: +•<x tis ..a _3 - .
BUILDING O/ . 6" L>L7 �f/'/J ,DISTRICT NO. GROUP MAP 'P 0 ESSED
BK PG
aCONTRACTOR
'
ADDREss v. .CONNECTION DATA .
CITY TEL.NO.4 `�� STATION 16 DEPTH 1
❑ STATE MANHOLE REFERENCE
REGISTRATION N0. COUNTY
NO. DESCRIPTION OF ORK FEE,
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF TION LENGTH FROM' - !.
SEPTIC"TANK,SEEPAGE PIT OR Y. CURB P.L. M.L. P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE's PRIVATE DVISPOSAL SYSTEM ER CONNECTING TO @ $1.00 P.C 0.
R NO. JO
B .
WORK TO HEE
CONNECTISR SEWER
OR
OUSEW@ $1.00
v G/ TRUNK PERMIT NO. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
' INDUSTRIAL
WASTE APPROVAL '
CHARGES
OWNEH'S PERNT s 2 00 CONNECTION CHARGE FEE
} AUTHORIZATION TOTAL FEE j61 6,-i)-
REIMBURSEMENT FEE
I HAVE.AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT. THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS: DATE INSPECTOR'S SIGNATURE
` TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ " NEW HOUSE SEWER r�i�ifd2i�lG
OWNER ORl� CONNECT ADDITIONAL
OWNERS.AGENT� � BUILDING OR WORK -
ADDRESS - 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 ALTER,REPAIR,SEWER OR "
PLUMBING AND SEWERS. : SEWAGE DISPOSAL SYSTEM _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
I•. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF '
HE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
CALIFORNIA OR T A. 1 AM T - '
DESCRIBED RESID N AL PROPERTY. s BACKFILL SEPTIC TANKS ❑
SIGNATURE a SEEP. PIT(S) ❑CESSPOOLS A °
OF PERMITT ZX z-
®F VALIDATION 'ROBERT A. WOOD
CK. M.0. cps SUPERVISING MECHANICAL ENGINEER
it i8 7 2`8niPi 41 0- A 6.0 0