HomeMy Public PortalAbout10010 LIVE OAK AVE_Sewer__ 76aa426f`
APPLICATION FOR, PERMIT `.
ceeoe•e•aa COUNTY OF LOS ANGELES1
SEWER—SEWAGE DISPOSAL-
DEPARTMENT OF COUNTY ENGINEER .
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAM M, County Enginoar
CASSATT D'. GRIFFIN, 3up't of Building
LOCALITY.
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL "
DESCRIPTION LOT NO. OWNER '
BLOCK TRACMAIL
T � -
. ADDRESS' �
NO.OF BLDGS. -
SIZE OF LOT ,NOW ON LOT CITY L. NO
USE OF
BUILDINGSRes, ff
UP MAP PROCESSED BY
^ K PG
CONTRACTOR Able G'OT18t2`
ADDRESS 225 W Bryant qC CTION DATA
CITY El Monte TEL. NO. Gi DEPTH
p STATNCE UPPER
REGISTRATION NO. 168 9 COULOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO -�v '�PUBLIC SEWER @ $8.00 NECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR RB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $8.00
OVERFLOW SEEPAGE PIT, DRAINFIELD-
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ 2.00 _
HOUSE SEWER CONNECTING TO P.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0
W TO HOUSE SEWER @ $1,00 . -
JALTEPJREPAIR OR ABANDON HOUSE STATE ENCROACHMENT
OR DISPOSAL SYSTEM Q $1.00 G' O PERMIT N0,- _
INDUSTRIAL
WASTE APPROVAL '
CHARGES
OWNER'S PERMIT $ 2100 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE O REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ APPROVALS DATE INSPECTOR'S SIGNATU
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEWER. `
SIGNED THIS AY O 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTJ� /��Y BUILDING OR WORK '
SEPTIC TANK, SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I
HEREBY ACKNOWLEDGE THAT.[ HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL El
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 RD L OPERTY. SEEPFPIT(BACKILL8 P❑C CESSTAN POOLS 11SIGNATUR
OF PERM jj
//
®F / y ALIDATION. ROBERT A WOOD _
1/1/scCJ//
M.
o. CASH SUPERVISING MECHANICAL ENGINEER