HomeMy Public PortalAbout5450 HILTON AVE_Sewer__ 5420 II.9'3
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5& APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
C./ O
JOHN A. LAMBIE. COUNTY ENGINEERI NEAREST
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CASSATT 0. GRIFFIN, SUr'T OF BUILOIrvG LOCALITY /}
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT 10.
MAIL
BLOCK TRACT - / ADDRESS CIA Z
NO. OF BLDGS. CITY TEL. NO. / (/
SIZE OF LOT NOW ON LOT �' ' {t`O C 0
USE OF
AP
BUILDINGS Ls S DISTRICT NO. GROUP M
`e BK PG
CONTRACTOR a 7
/ / CONNECTION DATA J
ADDRESS// li� (^ S T� L� 1-
CITY G -,,,STEL. r>D. ''// G - STATION � T 2 ^� DEPTN
r -7G �' MANHOLE REFERENCE '7 UPPER
c ��S1 ATE n l6 tG
REGISTRATION N0. �!
l J ❑ COUNTY -�
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIOjI� LENGTH FROM /
-/ HOUSE SEWER CONNECTING TO Y. CURB •l'P.U. M.L. TO IF.L.
I
PUBLIC SEWER @ $3.50 b
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ S 3.00
OVERFLOW SEEPAGE PIT, GRAINFIELD P. C. NO. vA
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ S 2.00 CO. IMP. N0. r IDB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE ) REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. ���// NEW HOUSE SEWER
SIGNED THIS�.,/DAY OF-�-'( 19�t_� CONNECT ADDITIONAL
OWNER OR /Jy ,/ BUILDING OR WORK
OWNERS AGENTL a5 /, SEPTIC TANK,SEEP, PIT(S)
ADDRESS q Z 2 x AND/OR GRAINFIELD
1 HEREBY A.CKNOW LEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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 SEWER$. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER. OF THE ABOVE
DESCRIBED RESIDENTIAL PROPEi / SEEP. P�T($E P ❑[TANKS CESSPOOLS❑
SIGNATURE
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CN. U. D. [ASW
I j,02 8 5 1' NOV 29 4 4.50
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