HomeMy Public PortalAbout9908-10 HOWLAND DR_Sewer__ X1650 INSER
C6D
TSA642D APPLICATION FOR PERMIT
azD COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS f
]OHN A. LAMBIE• Count,Evgineer
WILLIAM A. JENSEN. SuP•t of Building LOCALITY i Ci
NEAREST
FOR APPLICANT TO FILL IN caoss
T.
LEGAL '7 � ����..�� p
DESCRIPTION LOT NO. ) � OWNERZZa AV/j'� / ` GU Cr /SF TG�/(.A
BLOCK TRACTMAIL
'S ADDRESS O 0 li✓.
NO.OF BLOGS. ��.
SIZE OF LOT ' NOW ON LOT CITY c // EL. N0.
USE OF /J
BUILDINGS DISTRICT NO.I GROUP BK MAP ` OCESSED BY
CONTRACTOR
ADDRESS / CONNECTION DATA
CITY T/J.NO r STATION 5 6 DEPTH
STATE REGISTRATION N0. iCj ❑ COUNTY MANHOLE REFERENCE , / G , / UPPER
NO. DESCRIP ION F WOR FEE �/ v`i �f
HOUSE SEWER CONNECTING TO � EL-C' 3
PUBLIC SEWER @ $3.00 JE 0 CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN.. CESSPOOL.ORYWE LL @ $2.00
HOUSE SEWER CONNECTING TO13 P.C.NO.
PRIVATE 015POSAL SYSTEM @ $1.00 CO. IMP. N0. 6 JOB N0.
CONNECT ADDITIONAL BLDG.OR If �' TRUNK PERMIT NO. ROAD PERMIT NO. U
If WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00PERMIT N0. O
INDUSTRIAL V
WASTE APPROVAL M
CHARGES LO
OWNER'S PERMIT S 00 CONNECTION CHARGE FEE Ei
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE OESCR § D EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE .
SIGNED THIS DAY OF 19 NEW HOUSE SEWER - �:>✓, .. -?
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT I �- BUILDING OR WORK
ADDRESSC SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL [IWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR 'A
PLUMBING AND SEWERS. ALTER.REPAIR.
SEWERDISPOSAL EM
I HEREBY CERTIFY THAT 1 AM PROPERLY R TERED AND/OR SEWAGDISCONNECT PLUG AND r ,
LICENSED AS REQUIRED BY LOS ANGELES TY AND ST E OF
CALIFORNIA OR THAT AM T E OWNER OF TH ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDE PROPE Y. BACKFILL$ TANKS LlIT
SIGNATURE SEEP. SI) [3❑ CESSPOOLS ❑
OF PERMITTE //5
t\
®r VAL ( H ROBERT WOOD
CK. H.
0.0. GSH / SUPERVISING MECHANICAL ENGINEER
01 9 2 8 AUG ?8 1 G U 6.0, 0 `rD.