HomeMy Public PortalAbout5456 HILTON AVE_Sewer__ C %
CEB0828.88 APPL CAI N FOR ERMIT4"
COUNTY OF LOS ANGELES MESEWER-SEWAGE DISPOSAL 1
DEPARTNT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 7,0:�rL
M4Z16 ADpRE55IOHN A. LAMBIE, County EngineerCARBATT D. GRIFFIN, Supt a! Buildig LOCALITY
FOR APPLICANT TO FILL IN NEAREST7CROSSST. 4L �'�LEGAL
DESCRIPTION LOT NO. OWNERBLOCK TRACT MAIL ADDRESSN0OFBLDGS.SIZE OF LOT NOW ON LOT CITY ' .
USE OF
BUILDINGS +�1i�` / DISTRICT NO. GROOUUP pH MAP RO�C�ESSQED/��[BYY
CONTRACTOR .L f./� / ICT BK / ,o 7 I / "'�/�i
ADDRESS v = / �� CONNECTION DATA
CITY l 1 _ TEL.NO. jam- �Ni I�6? STATION DEPTH_ o � :� �-r�'d:a
^Y B CSTATE OUNTY MANHOLE REFERENCE / q� UPPER
REGISTRATION N0. �, V LOWER
No. DESCRIPTION OF WO FE
HOUSE
SEWER CONNECTING TO
-PUBLIC ER@ $5.00 1
TYPE OF CONNECTI P.L. - LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $Z.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOR N0. Sol
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ 31.00
ALTER,RE PAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT § 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 6'o REIMBURSEMENT FEE /Ay
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- " " r? 6/6 ("CTA.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY OF IJ_ NEW HOUSE SEWER
OWNER OR L',Ai:% CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S),
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL D DRYWELL D
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SEWER EM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
HO PLUGA D
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENJIA,V PROPERTY. � BACKFILLSEPTIC TANKS D
SIOF PERMEITTE SEEP. PITS) ❑ CESSPOOLS ❑
®r VALIDATION ROBERT A. WOOD
cm. M.0. GSH SUPERVISING MECHANICAL ENGINEER
Iia 1 1 4 .;da 13 1 o D 5.00