HomeMy Public PortalAbout6027 IVAR AVE_Sewer__ CE8082Y70 A P-14...�'� A II OON F®� r Gtlll�� 1/!!
76,A 642D
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION G BUILDING n +)- V, V
JOHN A. LAMBIE, COUNTY ENGINEER
ADDRESS
.i V
COLEMAN W. JENKINS, SUPT. OF BUILDING
LOCALITY
.IPRINT 'OR TY'..,-.., .,.._-... - ..
F R APPLICANT TQ FILL IN cRossssT.
a PE ONLY)
LEGAL
DESCRIPTION LOT NO. d- 4 r OWNER
MAIL r
BLOCK TRACT C/ �' / ADDRESS `�
Fi
SIZE OF LOT ,/� NOW
0-O�N'B LOTS CITY7r- � �•/�' TEL.
USE OF �l� / /�•`�`•'/.�
BUILDINGS DISTRICT NO.�G�DUP CLASS MAP PROCES D BY
IIK
I^ CONTRACTOR )`. ,QfZ/9/tJs I` /i� �/ ..' iy /,y _•
ADDRESS y E d.1�g,51,firJG-;r '`-- ,�`� CONNECTION DATA
CITY ' (())✓�°'C��+�/> TLE�L. NO. STATION l"t -� DEPTH
STATE ,7C7 O V JCLASS GGEF LICP ER-i
MANHOLE REFERENCE �S /
LICENSE NO;: �• LO EFt
NO. DESCRIPTION OF WORK FEE '- TYPE OF CON TION LENGTH FROM -M /
HOUSE SEWER CONNECTING TO i'. Y. URB P.L. M.L.TO P.L.
PUBLIC SEWER @_ss-cl -
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. �3 JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S3.00 TRUNK PERMIT NO. ROAD PERMIT NO. CL
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER "EASEMENT RECORD.INSTR. NO. D TE O
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL,DRYWELL.MANHOLE @ $5.00 O
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 ~
' STATE ENCROACHMENT W
PERMIT NO. 0-
INDUSTRIAL
INDUSTRIAL N
WASTE APPROVAL z
CHARGES
�j'�
OWNER'S PERMIT s / oo
AUTHORIZATION TOTAL FEE l e /1 f CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CC/ONC., REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING,
TO THE PUBLIC Sv �� ••�/ APPROVALS DATE IN ECTOR' S NATURE
SIGNED THI zY AY OF
OWNER OR >-,(.,. NEW HOUSE SEWER
OWNERS AGENT ry _ �.+
CONNECT ADDITIONAL '
ADDRESS 1 // _J - BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S)
AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED. BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR AM THE LEG L OWNER OF, AND I END TO ^ DISCONNECT PLUG AND
.RESIDE IN, T QD71RJBJ�,D'RESIDENTIAL PROPE Y. ABANDON HOUSE SEWER
SIGNATURE. ! BACKFILL SEPTIC TANKS 1:1OF PERM'r
E 111 SEEP.PIT IS) ❑ CESSPOOLS ❑
LIDATION JACK R. ALLEN
CK. O.• CASH SUPERVISING MECHANICAL ENGINEER
, ,
IN