HomeMy Public PortalAbout10314 LIVE OAK AVE_Sewer__ S&E-883 11.98 APPLICATION-
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER _ADDRESS� J�Ga' Q��
® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY J
FOR APPLICANT) TO FILL IN f,/ �1 CROSS ST.
LEGAL
OWNER7.RDECRIPTION LOT NOx MAIL
BLOCK TRACT' ADDRESS
^r
SIZE OF LOT
�D�C�C DONO. OF NOW ON LOTS CITY TEL. NO.
USE OF DISTRICT NO. I GROUP I MAP
BUILDINGS BK PG
CONTRACTOR y a- 0
CONNECTION DATA
ADDRESS �
STATION DEPTH .S
CITY �,d,yy.�,.- TEL. N0. _ 71, UPPE
MANHOLE REFERENCE/
12
STATE
REGISTRATION N0. fts ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
PUBLIC SEWER @ $3 50 �
P.L. M L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
ITS AND/OR DRAINFIELD @ $3 00 1
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. N0,
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO NO. JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT N0. ROAD PE ,IT NO,
CONNECT ADDITIONAL BLDG OR STATE CROA,CHMENT
WORK TO HOUSE SEWER @ $1 00 f D CJ PERMIT NO -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECT N CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE A,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY 0 19 CONNECT ADDITIONAL
OWNER ORBUILDING OR WORK
OWNERS AGENTJJ� SEPTIC TANK.SEEP, PIT(S)'
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL EDDRYWELL❑
AND 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
1HEREBY 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 RESIDENTIAL P RTY. BACKFILL SEPTIC TANKS[IBACKFILL
+ SEEP PIT(S) ❑ C SSPOOLS
_
OF PERMITTEE �.�f♦��®„ �, V ~l
SP
JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK `ACO 5 5 8 E Ln MAY 1 4 ,6.5 0 In