HomeMy Public PortalAbout5918 IVAR AVE_Sewer__ ,78A84213 A11 PUC(!"'NTMIIV FOR PEIlutlV11 Il �{(
S.&E-663 11.55 '
DIVISION OF BUILDING ARID SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer "fi
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 1-- 51
✓�L
F0 MA&PPLI T' T _ CROSS T.
LEGAL r
DESCRIPTION LO NO, - OWNER P
MAIL
' BLOCK " TRACT ADDRESST.. _
N0.OF
SIZE OF LOT LDGS. - CITY TEL. NO. �.
r NOW ON LOT
USE OF
BUILDINGS {f,�Y'.� P` DISTRICT N0. GROUP MAP
,BK PG
CONTRACTOR •,I.
CONNECTION DATA
ADDRESS
��/— STATION`"�� a DEPTH
CITY - TEL. N0. [ -
,: MANHOLE REFERENCE UPPER
j / w STATE _ LO
REGISTRATION NO. / )� s COUNTY
NO. DESCRIPTION 0 WOE` RK FE
TYPE OF TION LENGT
UBLIC SEWER @ $3_.50 H FROM
HOUSE SEWER CONNECTING TO Y. URB. P.L. M.L. TO P.L.
PJ C/
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD i O P. C. NO, "
EXTN.,CESSPOOL,DRYWELL,MANHOLE a $2.00 * CO. IMP. NO, 10B NO. '
HOUSE SEWER-CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $.1.00 TRUNK PERMIT N0. 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 @ $1.00 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE "
OWNER'S PERMIT 1 00 r
REIMBURSEMENT FEE. -
AUTHORIZATION TOTAL.FEE
I HAVE AT THIS .DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS - DATE _ INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - NEW HOUSE SEWER
SIGNED THIS. G DAYJOFy 'a 199 CONNECT ADDITIONAL
'OWNER OR �11�•� 'BUILDING OR WORK-
OWNERS AGENT --
SEPTIC TANK,SEEP,PIT(S) - -
ADDRESS 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. 1 SEWAGE DISPOSAL SYSTEM '
1 HEREBY CERTIFY THAT I AM PROPERLY REGI RED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELE .. OU AND /AVE
F ABANDON HOUSE SEWER
CALIFORNIA OR: THAT I. M THE LEG ER OF THDESCRIBED RESIDENTIA OPERTY. BACKFILL SEPTIC TANKS❑ `+-.. ,i'SIGNATURE - ' SEEP.PIT(S).0�CESSPOOLS �,.9.i'�/�,
OF PERMITTEE
JOHN-A. LAMBIE: G Y - NG[NEER ION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
bt.O, CASH45 0
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