HomeMy Public PortalAbout10510 LIVE OAK AVE_Sewer__ a
7HAPPLICATION FOR PERMIT - -
C68a08os 111-87 1 •
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL-1 i
DEPARTMENT'OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, Count F Ea eer ADDRESS-e!- [J t�•
CASSATT D. GRIFFIN, Sup t of Building
LOCALITY ✓ {i �y �_FL
NEAREST
FOR APPLIC T FILL IN CROSS ST. _
FDR
" t
OT N0. OWNER
TRACMAIL
T ( ADDRESS ,Q`
M t l
N0.OF BLDGS. _NOW ON LOT CITY TEL:NO',
USE OF
BUILDINGSI
RICT NO. GROUP MAP
-� BK P
CONTRACTOR � -G
ADDRESS /'
CONNECTION DATA
CITY � TEL.NO. � N DEPTH
LE REFERENCE UPPER
REGISTRATION NO �✓NO. DESCRIPTION OF WORK E / pHOUSE SEWER CONNECTING TO /(p /PUBLIC SEWER $3YPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT ORPITS AND/OR DRAINFIELD @ $3.00 CURB .L. ML.TOP.LOVERFLOW SEEPAGE PIT,DRAINFIELD
XTN.,CESSPOOL,DRYWELL,MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00' .NO. JOB NO
CONNECT ADDITIONAL BLDG.ORWORK TO HOUSE SEWER @ $1 00PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1 00ENCROACHMENT
NO.
_ -INDUSTRIAL
• WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL, FEE REIMBURSEMENT FEE ^
1 HAVE-AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF '`— 19 NEW HOUSE SEWER `
OWNER OR A. -- - - -- - -CON NECT•ADDI-TIONAL -• -/ -
OWNERS AGENT - ap
BUILDING-OR-WORK
SEPTIC-TANK,SEEP,PIT(S) -- - - - -- -
ADDRESS- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - �,.1 �1.7 '
AND STATE THAT THE ABOVE JS CORRECT AND-AGREE TO COMPLY._ -CESSPOOL-[] DRY-WELL C] =- -- - ------ -^^--
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER.REPAIR,SEWER OR
I-HEREBY CERTIFY THAT I—AM PROPERLY REGISTERED'-AND/OR -SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED Y LOS ANGELES COUN AND STATE OF DISCONNECT PLUG AND /
CALIFORNIA OR THAT !_SAM -THE_LEG L,.O R OF THE A E-. ABANDON HOUSE SEWER
DESCRIBED RESIDE PROPER'LY� ��,{ � SEEP.FPIT(S) CESSPOO❑ ❑ �
SIGNATURE , - i/"7/!Y' _.9 - -• - --- .
OF PERMITT
®e - _ - VALIDATION __ _ ROBERT"A. WOOD _.
CK N.o CASH SUPERVISING MECHANICAL ENGINEER
- -- - - - = -- 1 -6'O r2 f;- JAN '7 1 O A - - 5-0-0-
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