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HomeMy Public PortalAbout5475 HILTON AVE_Sewer__ 98A04APPLICATION FOR PERMIT 1 5@EB6DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING • �' JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS y ® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS LEGAL DESCRIPTION LOT NO. IX^� , L OWNERMAH p� --/ Q ,J a ADDRESS I BLOCK TRACT // 11. NO. OF BLDGS. CITY TEL. NO. -(y-O(ri'O SIZE OF LOT NOW ON LOT / USE OF DISTRICT NO. GROUP MAP BUILDINGS BK PG CONTRACTOR �, ,..J .�. ) ADDRESS f' CONNECTION DATA STATION T DEPTH • ' CITY C j�.��-.cTEL i0. .^C .�� MANHOLE REFERENCE � UPPER TATE REGISTRATION NO. 9�(%� []COUNTY C N0. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO y y, CURB ,L, M.L.TO P.L. PUBLIC SEWER @ S 3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 /q. OVERFLOW SEEPAGE PIT. DRAINFIELD CO. IMP. N0. JOB N0O L rC� EX TN.,CESSPOOL,DRYWELL,M AN HOLE ((1 $2.00 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 @ S I.DO PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM © $].Do WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT s 1 00 AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE I I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED N- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS 2, OF z� t 19� CONNECT ADDITIONAL OWNER OR Ir BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS .h'.I 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 AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT ABANDON HO PLUG PLUGUSE D CALIFORNIA OR THAT I All THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ Z SIGNATURE I, SEEP. PIT(S) ❑ CESSPOOLS L)OF PERMITTEE . JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK, N.0, ASX 2 a 5 2N KV 29 a 4.5 O