HomeMy Public PortalAbout5467 HILTON AVE_Sewer__ S&E-66311-55 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 O. GRIFFIN. SUPT OF BUILMN. LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,
LEGAL O /�I/ � v��
DESCRIPTION LOT N0. 8 OWNER J♦ /��.
BLOCK TRACT / MAIL
ADDRESS
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT GROUP MAP
BUILDINGS PO
. CONTRACTOR
ADDRESS CONNECTION DATA
CITY �f�/ ,.`'�,(., TEL. N T�-5!(0(6) STATION E DEPTH
.
MANHOLE REFERENCE '�G'. � !/ _ PPER
/ {J
REGISTRATION N0. i �a,�6 ❑ COUNTY
No. DESCRIPTION OF WORK FEE
PUBLICHOUSE
SEW ER ER CONNECTING TO @ $3.50 'l TYPE OF CON ONS MELGTOH PF L M �J� /
SEPTIC TANK,SEEPAGE PIT OR (J
PITS AND/OR DRAINFIELD C $3.00
OVERFLOW SEEPAGE PIT, GRAINFIELD P. C. N0.
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 CO. IMP. NO. 108 NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE' INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $I. WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PERMIT S 1 OD
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE _
1 HAV6 AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSP�CTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWERr NEW HOUSE SEWER 044-.5
SIGNED THIS �'s DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT /-- - / SEPTIC TANK,SEEP,PIT(S)
ADDRESS-/If ANO/OR GRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYWELL❑
ANO 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCABAON HO PLUGAUSE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE - ,
ER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE
• SEEP.PIT 151 LI CESSPOOLS❑
OF PERMITTEE -
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. X.O. CASH
� i 1 9 7S AUG15 4. 4.50