HomeMy Public PortalAbout8756 LESLIE DR_Sewer__ d
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76A642D APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS8756
WILLIAM A. JENSEN, Sup't of Building ie •
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS STLUSCate Avg.
LEGAL
DESCRIPTION LOT NO OWNER
MAIL 'Meberi
BLOCK TRACT 29902
ADDRESS
NO OF BLDGS O Blvd.
SIZE OF LOT NOW ON LOT 71 CITY TEL NO
USE OF
BUILDINGS ,+
Residence a UP DISTRICT NO GROAP PROCESSED BY
BK n
CONTRACTOR G'll�/�P
He=y B. Vega
ADDRESS 3245 N T
CONNECTION DATA
STATION - DEPTH
CITY ,C NO � �i
STATE MANHOLE REFERENCE 1� UPPER
REGISTRATION2 2525 COUNTY L-e,rve
NO CESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO __ Y CURB L ML TOP IL
PUBLIC SEWER @ $5 00 P C NO
SEPTIC TANK,SEEPAGE PIT OR JOB NO L O
PITS AND/OR DRAINFIELD @ $1000 CO IMP NO V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ 5300 ^
CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAlv[R E�SfM[NT RECORD INSTR NO DATE 0
WORK TO HOUSE SEWER @ S300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN,CESSPOOL,DRYWELL,MANHOLE @ $5 00
ALTER REPAIR OR ABANDON HOUSE _ HWY OR ST WIDENING - h
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT Z
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00
AUTHORIZATION ' FEE l� CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEME NT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPEC ORS SIGNATURE
SIGNED THIS DAY OF 19_ ( _
OWNER OR NEW HOUSE SEWER �j` X, I
OWNERS AGENT CONNECT ADDITIONAL '
New BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
IH
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY T I M PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REO ED BY OS ANGLES COUNTY AND S TE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR T AT I AMr HE LEGAL OWNERC F, AN IN NO TO DISCONNECT PLUG AND
RESIDE IN THE BOVE DESCRIBED RESIDEL PR ER ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTE SEEP PIT(5) ❑ CESSPOOLS ❑
VALIDATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK M O ASH
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