HomeMy Public PortalAbout5460 HILTON AVE_Sewer__ seE.69,,.,, APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment 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 caoss sT.
LEGAL
DESCRIPTION LOT NO. OWNER 13 A/�C /�VjII�IiY 1 1�
F'1 I MAIL _z 4
BLOCK �T�RyA�CT ADDRESS
SIZE OF LOT V✓o' 0. OON LQF DTS CITY ,. r4l& I TEL. NO. T 6-01{0 7
USE
BUILDI,I NGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR AW
ADDRESS f, 4CONNECTION DATA
STATION DEPTH
CITYTEL. NO.� (j MANHOLE REFERENCE
/�
C) STATE LOWER
REGISTRATIO N0. amlmo"� ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO t TYPE OF CONNECTIOP.L LENGTH FROM yy
PUBLIC SEWER @ $3.50 Ll Y. CURB M.L.TO P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ IS 3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYW ELL,MANHOLE @ S 2.00 CO. IMP. NO. JOB NO. 73 L/
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ 51.00 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 @ S 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
REIMBURSEMENT FEE
AUTHORIZATION ITOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INS CTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEWER. NEW HOUSE SEWER 1 etin
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 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 PROP RTY. BACKFILL SEPTIC TANKS❑ _
SIGNATURE ` SEEP. PIT(S) El CESSPOOLS❑ ,
OF PERMITTEE 1 � ' ppp��*
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION_ ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CN. N. 0. CCFH
L'L4 6 9 1—� FEB 1 4 4'.50 to