HomeMy Public PortalAbout5919 IVAR AVE_Sewer__ APPLICAT�ON . FOR PERMIT
ctseoe 11-57 COUNTY OF LOS ANGELES
SEWER— EWAGE SP®SAL
DEPARTMENT OF COUNTY ENGINEER /��j /®j I/
BUILDING AND SAFETY DIVISION BUILDI SG /j
! /• -+
JOHN A. LAMBIE, County Engineer
CASSAIT D. GRIFFIN, Supt of Building LOCALITY �.
FOR A PLI+AIQT TO FILL IN CROSS ST.
LEGAL
• —11
DESCRIPTI s OT LN0. 2, OWNER
BLOCK TRACT MAIL
ADDRESS -/ -
NO.OF BLDGS.
IZE OF LOT NOW ON LOT / CITY TEL.NO.
,F BUE DINGS, ��`- �ifG � DISTRICT NO. GROUP x `MAP `
CONTRACTOR- (✓ /, J �" v I I K
ADDRESS .a,% F< --7/`".f, CONNE TION DATA
CITY ,� �� TEL.N STATION DEPTH -
REGISTRATION NO. �j Jj ❑ STATE MANHOLE REFERENCE UPPER
❑
Ci COUNTY _
NO, DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO 6 ,�
PUBLIC SEWER @ $3: '
SEPTIC TANK,SEEPAGE PIT OR TYPE OF C,0MqzECTION LENGTH FROM f
PITS AND/OR DRAINFIELD @ $3.00 Y. URB) P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOP.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. / ',�, JOB
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO,�
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
9 PERMIT NO.
_ INDUSTRIAL
T. WASTE APPROVAL
-� - CHARGES
OWNERS PERMIT S 00 CONNECTION CHARGE FEE
AUTHORIZATION - `
TOTAL FEE � REIMBURSEMENT FEE
t HAVE AT .THIS DATE A-CONTRACT WITH THE HEREIN NAMED CON. -
TRACTOR TO CONNECT THE ABOVE DESCRIBED IISTI.NG DWELLING APPROVALS DATE INSPECT 'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY f g NEW HOUSE SEWER
OWNER OR - -CONNECT ADDITIONAL - - - - -
OWNERSAGENT "�� BUILDING OR WORK
_ SEPTIC TANK,SEEP,PIT(S)
ADDRESS -AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAV READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL(:1 -- - -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -
PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR
I HAgEY-CERTIFY THAT- I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LI ED AS R UIR BY LOS LES COUNTY AND STATE. OF DISCONNECT PLUG AND
CA ,0RN1'A'0 TH I A THE OWN OF THE ABOVE ABANDON HOUSE SEWER s-
D C114BER .� �""f. BACKFILL SEPTIC TANKS ❑
SIGNATURE y t - SEEP. PIT(S) CESSPOOLS ❑ / -,-
OF PERMITTE
Or VALMATIO ROBERT A. WOOD
CK, b,o. CASH SUPERVISING MECHANICAL ENGINEER