HomeMy Public PortalAbout8762 LESLIE DR_Sewer__ J
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76A642D APPLICATION FOR PERMIT
6A64
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBLE, County Engineer ADDRESS
R762 T,P..qlie Dr .
WILLIAM A. JENSEN, Sup't of Building San Gabriel
LOCALITY Ave.
'
NEAREST
FOR APPLICANT TO FILL IN S. ST A
Muscatel
LEGAL
DESCRIPTION LOT NO OWNER
MAIL Weber Y
BLOCK TRACT 29908 ADDRESS 6 T
NO SIZE OF LOT NOW OON LOTS 1 CITY y m♦ C 0 TEL NO
USE OF Residence DISTRICT INGROUP 1, PROCESSED BY
BUILDINGS
CONTRACTOR
ADDRESS 32�ry4T5 N. Ivan Ave CONNECTION DATA
CITY
SSG . -TEL NAt o 0-4772 STATION DEPTH
��.-.I{ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO LJ COUNTY I.�G 1q
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIONLENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB L ML TOP L }
PUBLIC SEWER @ E5 00
P G NO a
SEPTIC TANK SEEPAGE PIT OR O
PITS AND�OR DRAINFIELD 510 00 CO IMP NO
- .108 NO
HOUSE SEWER CONNECTING TO
V
PRIVATE DISPOSAL SYSTEM $3 00 TRUNK PERMIT ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE O
WORK TO HOUSE SEWER @ 5300
OVERFLOW SEEPAGE PIT,DRAINFIELD V U
LU
EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 4.
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h
SEWER OR DISPOSAL SYSTEM @ E3 00 STATE ENCROACHMENT Z
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00
AUTHORIZATION TOTAL FEECONNECTION 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 INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF -19-
OWNER
9_OWNER OR NEW HOUSE SEWER
OWNERS AGENT New CONNECT ADDITIONAL
��Y BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT /11ESOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTWN*+lCES AND STATE LAWS REGULATING
PLUMBING AND SECESSPOOL ❑ DRYWELL ❑I HEREBY CER Y THAT I �M PROPERLY REGISTERED T'AND/OR ALTER,REPAIR SEWER OR
LICENSED AS QUIRED BY�COS ANGLES/ TY
AND TATE OF SEWAGE D ISP'SAL SYSTEM
CALIFORNIA O THAT I AM/THE LEGAL O ER O AND NTEND TO
/ DISCONNECT PLUG AND
RESIDE IN, T E AB B/fSESCRI BED R TI?yL ROPERTY ABANDON HOUSE SEWER
SIGNATURE C�// BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP PITS) ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
CK M O CASH p ^ �J
i..tLlvt� a c� J�D ft¢�119-L1 `J 1't