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HomeMy Public PortalAbout6118 IVAR AVE_Sewer__ ceeoe-e-se COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF .COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING , ADDRESS IOM A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Supt of Building - LOCALITY » - NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL J/ DESCRIPTION LOT NO. OWT_, /y BLOCK TRACT MAIL �'S�(i �� ADDRESS - N0.ITIF BLDGS. - SIZE OF LOT-50 NOW ON LOT - CITY TEL.NO. ' USE OF .7.7 BUILDINGS DISTRICT NO. (R BK MAP PG 1 74 OCES BY CONTRACTOR b -. ADDRESS l' j-�.Ib—_�-/,G CONNECTION CITY TEL.NO. �f � —n STATION DEPTH ATE MANHOLE REFERENCE UPPER REGISTRATION NO. COUNTY ' NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO !, PUBLIC SEWER @ $3.00 SEPTIC TANK,SEEPAGE PIT OR TYPE OF ON LENGTH FROM Y. CU P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 - OVERFLOW SEEPAGE PIT, DRAINFIELD +. EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 HOUSE SEWER CONNECTING TO f P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 » CO..IMP.NO. J7 •� .JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK'PERMIT NO. -ROAD PERMIT N0. WORK TO HOUSE SEWER @ $1.00 P"(- -1 SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 - STATE-ENCROACHMENT , PERMIT NO. ti INDUSTRIAL r. WASTE APPROVAL a CHARGES OVMEWS PERMIT 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE y REIMBURSEMENT 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 _ . n . TO THE PUBLIC SEWER. ® SIGNED THIS PAY OF � NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGE NT/ c BUILDING OR WORK ADDRESS �(/`.O 7"C.. SEPTIC TANK,SEEP;PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION t AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑ F WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR _ PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ' DISCONNECT PLUG AND LICENSED ASI REQUIRED BY LOS ANGELES COUNTY AND. STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT t AM THE LEGAL R OF THE ABOVE ` DESCRIBED RESIDEN AL PROPERTY._ SEEP.BACKFPIT(S)ILL P❑C CESSPOOTANKS LS❑ SIGNATURE � L ` OF PERMITTE ®r ALIDATIROBERT WOOD K. M.o, cASH "SUPERVISING MECHAA NICAL ENGINEER : © R 5 .00