HomeMy Public PortalAbout6276 HART AVE_Sewer__ CES08.8.88 All PUC/r TMU FOR PERMT .
COUNTY OF LOS ANGELES SEWER-SEWAGE DESPOSAL
DEPARTMENT OF COUNTY ENGINEER ,_.d. . .A' w
BUILDING AND SAFETY DIVISION ADDRESSG ltfy t� J p �J&C
JOHN A. LAMBIE, County Engineer n
CASSATT D. GRffFIN, Supt of Building LOCALITY
9 r FOR APPLICANT �.
v
TO FILL IN _ceOS,ST. /;�M JI ✓1
LEGAL
DESCRIPTION LOT NO. 7 OWNER Lh71
,
` BLOCK TRACTMAIL
> 6.41 A ` ADDRESS ., ddi"R..
SIZE OF LOT NOW ONBLOTS / CITY TEL.NO.
USE OF I - - �. .c
.r .- F;....;,
^, BUILDINGS ADISTRIC7 N0. GROUP MAP PROCESSED BY
BK P6
CONTRACTOR
ADDRESS _. CONNECTION DATA -
CITY TEL.N ! STATION DEPTH
,r ❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ❑ COUNTY
r NO. DES(-P1F'r10N-0FW0R1T F
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 - TYPE OFC CTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR a y, P.L. M.L.TO P.L730.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE'PIT, DRAINFIELD
E%TN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOP.C.NO. -
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.iMP. NO. a ic, JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
3 ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
.* SEWER OR DISPOSAL SYSTEM @ $1.00 ° PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVMEWS PERMIT $ 2 OD CONNECTION CHARGE FEE
r AUTHORIZATIONTOTAL FEE �'C d REIMBURSEMENT FEE
c I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED (STING DWELLING
TO THE PUBLIC SEW • 4-9
OWNERSIGNED .THIS--r DAY///OF ]9 NEW HOUSE SEWER -2 `�
OWNER OR /¢ (� q t - CONNECT ADDITIONAL
LADDRESI-
S AGENT- /y.� ( �rL-'I-3,*1 .:�• .'� BUILDING OR WORK
S D '� * l ''/'tea.` U� - SEPTIC TANK, SEEP,PIT(S)
AND/OR DRAINFIELD -
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ''4 CESSPOOL❑ DRYWELL❑ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGpLTER, REPAIR, SEWER OR
ING AND SEWERS. SEWAGE DISPOSAL SYSTEM
REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORDISCONNECT PLUG ANDED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF pgpNDON HOUSE SEWER
RNIA OR THAT 1 AM THE LEG WNER OF TH ABOVEIBED RESIDEN PROPERTY. BACKFILL SEPTIC TANKSURESEEP.PIT(S) ❑ CESSPOOLS
RMITTE 4 J1/ /VO 7- 7�C Q 214
0" VALIDATIO ROBERT A.WOOD
jbAytiJ SUPERVISING MECHANICAL ENGINEER,
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