HomeMy Public PortalAbout5472 HILTON AVE_Sewer__ SE-6°
& APPLICATION FOR PERMIT
eeDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS /S�/L my LLUN,
® CASSATT O. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO £ILL IN CROSS ST
.OQ/yes OPiu
LEGAL C OWNER !j �o
-DESCRIPTION LOT N0. J �® /J !t{6O Q.t4 dU
MAIL J
BLOCK TRACT
wwAw X� k NO.OF BLOCS. ./
CITY
SIZE OF LOT-f(Y/X/2'G� NOW ON LOT Lo TEL. N0. NOae
USE OF
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BUILDINa/SPK DISTRICT NO. GROUP MAP
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c� BK PG
CONTRACTOR A D
CONNECTION DATA
ADDRESS
CITY TEL. NO. STATION S DEPTH '
MANHOLE REFERENCEUPPER
El STATE
-W.
WER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIOf LENGTH FROM
Y. CURB P.L. M.L. TO P.L.
_
PUBLIC SEWER @ g3.50 CS
SEPTIC TANK,SEEPAGE PIT OR Nx N1 FMVLA
PITS AND/OR DRAINFIELD Q $3.00 I
OVERFLOW SEEPAGE PIT,DRAINFIELD P.Iff. NO.
EXTN.,CESSPOOL.DRYWELL,MAN HOLE Q $ 2.00 _ JOB NO.
HOUSE SEWER CONNECTING TO ! 1
PRIVATE DISPOSAL SYSTEM Q S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR ,X STATE ENCROACHMENT
WORK TO HOUSE SEWER Ca S 1.00 C" PERMIT 10.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
_
SEWEP OR DISPOSAL SYSTEM (= $1.00 WASTE APPROVAL
lZvl �.� CHARGES
0401,4 CONNECTION CHARGE FEE
OWNER'S PERMIT s t 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED N-
APPROVALS DATE INSP NATURE
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER B s/
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR GRAINFIELD
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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 Ah THE LEGAL OWN I OF THE ABOVE
DESCRIBED RESIDE L PR ERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LA IE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG, INSPECTOR
CK. Y. 0. CASH
UC03 4 8 5.4 AUG 4 10 LA 5.5 0 M