HomeMy Public PortalAbout8752 LESLIE DR_Sewer__ 10-63
76A642D APPLICATION FOR PERMIT
6A64
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building
Leslie DrFOR APPLICANT TO FILL IN 77
LEGAL
DESCRIPTION LOT NO OWNER
MAIL Weber •
BLOCK TRACT ADDRESS
.5926 N. T- C 'R-l7vd . 1
O OF SLOGS
SIZE OF LOT NOW ON LOT CITY T C TEL NO
USE OF Residence DISTRICT NO GROUP MAppp n PROCESSED BY
BUILDINGS my l�,11_�
CONTRACTOR -P'lu�/ O Vega
vY1�YU � v
ADDRESS • CONNECTION DATA
STATION DEPTH
CITY TEL NO
P COUNTY STATE MANHOLE REFERENCE i z UP
PER
REGISTRATIO2 W 52 5
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION /._ LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB M L TO P L
PUBLIC SEWER @ 55 00
SEPTIC TANK,SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD @ 31000 CO IMP NO JOB NO /� O
V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3 00 Im
O
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300 V
OVERFLOW SEEPAGE PIT DRAINFIELD W
EXTN CESSPOOL,DRYWELL MANHOLE @ E5 00 Q�
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING (y/�
SEWER OR DISPOSAL SYSTEM $3 00 STATE ENCROACHMENT L
PERMIT NO
INDUSTRIAL
OWNER'S PERMIT
WASTE APPROVAL
CHARGES
E z o0
AUTHORIZATION TOTAL FEE --47- CONNECTION
EECONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE ,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECT R S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER ,
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS Hew BUILDING OR WORK
SEPTIC TANK SEEP,PIT(S) •
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 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 REQUIR Y LOS ANGLES Ci AND STATE OF SEWAGDISCONNECT
ECTDISPLUG
SYSTEM
CALIFORNIA OR T I A THE LEGAL OWN E F, ND TEND TO DISCONNECT PLUG AND
RESIDE IN, THE OVE ESCRIBED RESIDE L P OP TY ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTE SEEP PIT(S) ❑ CESSPOOLS ❑
VALIDATIO ROBERT A. WOOD
CK M O
SUPERVISING MECHANICAL ENGINEER
CASH
LAW (J 8 8 7:01 it?R ,26 1 Q A TO 0
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