HomeMy Public PortalAbout10511 KEY WEST ST_Sewer__ OF 40`T# l2
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APPLICATION FOR PERMIT 1
S @ E 6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDIN
JOHN A LAMBIE, COUNTY ENGINEER ADDRES
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY
Fq§ APPLI ANT TO F LIN ceoss srla,e
LEGAL OWNER
DESCRIPTION LOT N ^� ava J; MAIL
BLOCK , TRACT 210 //9 040 ADDRESSxmw
¢J NO 40F B DGS CITY TEL NO /r4 ®'pD
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTR CT NO GROUP MAP
BK PG
CONTRACTOR L
ADDRESS - CONNECTION DATA `
a STATION �' DEPTH 42
CITY TEL NO167' U PER `
MANHOLE REFERENCE
❑ STATE o
REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE
TYPE OF ION LENGTH FROM
HOUSE SEWER CONNECTING TOY, URB P L M L TO P L
PUBLIC SEWER @ $3 50 I 57p
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP NO // JOB NO
HOUSE SEWER CONNECTING TO 17
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT 10 ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT 41
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Qi $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 10
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA ED C APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER J NEW HOUSE SEWER lY
SIGNED THIS DAY C 190 re CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESSZeAeryyAND/OR DRAINFIELD
I HEREBY ACKNOWLEQAE THAT 1 HAVE READ THIS AP (CATION CESSPOOL[IDRYWELL ElAND 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 SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE ^^^ SEEP PIT(S) CESSPOOLS
OF PERMITTEE �D' /// �+� u El/,r//>
JOHN A LAMBIE, COUNTY ENGINEER LIDATIO ROBERT A WOOD, CHIEF PLBG INSPECTOR
M O CASH
AC,0 5 4 5 7 APR 2 6 4 4,.5 0 �'