HomeMy Public PortalAbout5471 HILTON AVE_Sewer__ TEMPLE CUTY
9
0zoe 6086.eP APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
MBADDRESS a/ ♦ "!♦/ ✓�
IOHN A. LAIE. County Ea sar
CASSATI' D. GRIFFIN, BuP t of Building LOCALITY
FOR APPLICANT TO FILL IN
NEARET 01
CROSS 5T. rye S
LEGAL
DESCRIPTION OWNE09W � r/J7(
. / J'
BLOCK TRACT MAIL ``� 1 / �"�
3 ADDRESS�d/
SIZE OF LOT NOW ON LOTS CITY / L C.. TEL. N0. - �' 0
USE OF �
AQQ DISTRICT N0. GRO�Ip MAP P C D BY
QST C�
BUILDINGS C
,�j /� //�� F I PG
CONTRACTOR /✓E �K—' D � (``/�•"^L
ADDRESS CONNECTION ATA
CITY TEL.NO. STATION Z DEPTH
STATE MANHOLE REFERENCEUEE
REGISTRATION NO. B COUNTY ♦ I
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO M7
PUBLIC SEWER @ $3.00 V✓ TYPE OF CONNECTION LENGTH FROM c
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L M.L.TO P.L.
PITS AND/OR DRAINFIELD @ 83.00
OVERFLOW SEEPAGE PIT.GRAINFIELD
EXTN.. CESSPOOL.DRYWE LL 52.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER.REPAIR OR ABANDONHOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ 81.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE) INSPECTOR'S SIGNATURE
TO THE PUBLIC,$EWEi�
SIGNED TH NEW HOUSE SEWER
OWN CONN ECT ADDITIONAL l� '
OWNS S. - BUILDING OR WORK
ADORES /✓ •+r�- i/ �-♦ SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE REPAIR,
SEWER
OR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REGUI RE BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
EM
CALIFORNIA OR A 1 AM THE GAL OWNER OF XE ABOVE
DESCRIBED R AL PROPE BACKFILL SEPT IC TANKS ❑
DESCHI SEEP. PITS ❑ CESSPOOLS
OF P
2)' VALIDATION ROBERT A. WOOD
CL
Ill.0. CAetl SUPERVISING MECHANICAL ENGINEER
U,J,0 2 7 6 hb1P 30 1 0 5.00