HomeMy Public PortalAbout10140 LIVE OAK AVE_Sewer__ 78A6420 APPLICATIONCE808 11-87 FOR PERMIT' 'RMIT -�
COUNTY OF LOS ANGELES SEWER---:!SEWAGE. DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIL,'County En meet t e
ADDRESS V- �
CASSAIT D. G3127M, Supt of building LOCALITY
;LOT —
PPLICANT TO FILL IN
NEAREST.
LE
DESN0. OWNER s"I- 7•v•rl jZ
BLOACT MAIL �, -
ADDRESS
NO OF BLDGS.
SIZENOW ON LOT CITY - TEL.NO. - •�'
USEBUIDISTRICT NO. GROUP MAP
CONI"� PG
BPADD /� �- �- --� J CONNECTION DATARCIT (Z TEL. �fG 2 STATION DEPTH
STATE MANHOLE REFERENC PPE
REGISTRATION NO COUN A# CMER
no DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO v�
PUBLIC SEWER @ $S•
SEPTIC TANK,SEEPAGE PIT OR TYPE 0 CONNECTION LENGTH FROM ITS AND/OR DRAINFIELD @ $9.00 Y. CURB P.L. M L TO P.L
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00
HOUSE SEWER CONNECTING TOP,C 0.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO. JOB N0N. /,,5 / 0
CONNECT ADDITIONAL BLDG.OR ,
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO
{ _ _INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMT $ TdL 00 CONNECTION CHARGE FEE
AUTHORIZATION - " -
TOTAL,FEE REIMBURSEMENT FEE
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGA CONTRACT WITH-THE-HEREINAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF _ ! 19_ NEW HOUSE SEWER
OWNER OR - -- ----- - -- - ••- .-• - - - CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
ADDRESS" - '- '--'--' - - - -SEPTIC-TANK,SEEP,-PIT(S) - - .- - - -; -••
AND/OR DRAINFIELD' -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .._ - _ .•
AND STATE_ THAT THE ABOVE IS CORRECT-AND AGREE.TO COMPLY- CESSPOOL-0 DRYWELL-❑ - -- - - -WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I 'HEREBY 'CERTIFY THAT 1 "AM -PROPER LY•"REGISTEREO AND/OR SEWAGE DISPOSAL SYSTEM--- - - -_- -- •.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - DISCONNECT PLUG AND
CALIFORNIAOR T AIj 1. AM_THE -L GAL�OWNER OF THE ABOVE- ABANDON HOUSE SEWER
DESCRIBED REST IAL PROP TY. BACKFILL SEPTIC TANKS❑.
SIGNATURE_
SEEP PIT(S) [I CESSPOOLS ❑
_
OF PERMITT 17
- AIMATION - —ROBERT A. WOOD
�- cK. H.o ,cAs-H SUPERVISING MECHANICAL,ENGINEER _
-- L�(;o 5. 5- 7-8 - APR-?3 1-� A - 3.0 0 n
- - - - - - `/d�* �� --