HomeMy Public PortalAbout5455 HILTON AVE_Sewer__ 20-6D 11-99
6&EAPPLICATION FOR PERMIT 1
6 8 6.
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY,� �(' '
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL / OWNER
DESCRIPTION LOT NO.
,2 V IA,tflACT �G J MAIL
BLOCK
n/V 7 / —ADDRESS
NO. OF BLDGS. . '�/ CITY EL. N S—
SIZE OF LOT NOW ON LOT
USE OF ` DISTRICT NO. GROUP MAP
BUILDINGS �j/dJE/IG1'� BK PG
CONTRACTOR ,� o `�_ r & /0
--4 CONNECTION DATA
ADDRESS ���,,,��� ��� /{/�� /• �/ �1
�:(/,/nNO ff/ O/o 6'GL D STATION �L. DEPTH
CI Y s/� TEL. N0.
LT y MANHOLE REFERENCE y � PPER
❑ STATE A
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSESEWER CONNECTING TOTYPE OF CONNECTI LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ S 3.00
OVERFLOW SEEPAGE PIT,GRAINFIELD P. C. NO.
EXTN.,CESSPOOL.DRYW ELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM C $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
WORK TO HOUSE SEWER C $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (F $1.00 WASTE APPROVAL
C R 5
CONNECTION CHARGt FEE
OWNER'S PERMIT $ 1 00
REIMB RSE- FEE
AUTHORIZATION TOTAL FEE 50
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE IN ECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DES RIBEO EXISTING DWELLING
TO THE PUBLIC SEWS NEW HOUSE SEWER r'
SIGNED THIS ��
DAY OF 19, CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE 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 SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY TM6YLOSHEANZCO
ISTERED AND/Ofl DISCONNECT PLUG AND
LICENSED AS REQUIREDTY ANO STATE OF ABANDON HOUBE SEWER
CALIFORNIA OR THAT ER OF THE A9OVEDESCRIBED RE$ ENTI ,y / BACKFILL SEPTIC TANKS❑
SIGNAT UBE �_'•G.�-6//ASG/�JSEEP, PIT(S) [] CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
Ck. M.O. CASH
_�10 9 r
FIA 13 4 4.5 0