HomeMy Public PortalAbout10522 LIVE OAK AVE_Sewer__ E-6D89 11.89
S@ APPLICATION POR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY4�
FOR APPLICANT,,,���ppppTO FILL IN CROSS ST C�
LEGAL �. Q� 10 F �� OWNER
DESCRIPTION LOT NO VV IIt��
MAIL -2
BLOCK TRACT IVF (z ADDRESS
�i NO OF BLDGS
SIZE OF LOT?tX ` 50
NOW ON LOT CITY TEL. NO.
USE OF 4
BUILDINGS DISTRICT NO. I O P MAP
PG
/�� e
CONTRACTOR n 0"'/1 o i
ADDRESS � �C
OONNIE�CTION DATA'
1ji p rAee. _ STATION • EPTH
TEL. NOCITY y d �e
eml MANHOLE REFERENCE
e -�1� J ` n ❑ STATE 'S"� LOWER
REGISTRATION NO iXo •'� e ms' ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTI LENGTH FROM
PUBLIC SEWER @ $3 50
� Y. CURB PL_ ML TOPL
SEPTIC TANK,SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT.DRAINFIELDP. C N0.
EXTN ,CESSPOOL,DRYWELL,MAN HOLE @ $2 00 CO IMP. NO. C9 JOB NO
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
- CONNECTION CHARGE FEE _
OWNER'S PEIMT $ 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
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 01_
TO THE PUBLIC SEWKR. NEW HOUSE SEWERo �e
SIGNED THIS DAY OF 19
CONNECT ADDITIONAL
OWNEROR BUILDING OR WORK - -
OWNERS AGEN SEPTIC TANK,SEEP, PIT(S)
ADDRESS f AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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
c�
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 BOVE
DESCRIBED RESIDENTIAL P PERTY BACKFILL SEPTIC TANKS❑ 2
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑ "2'2
OF PERMITTEE -
JOHN A. LAMBIE, COUNTY ErAIAEER VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
6?LCO39 EE.0. CASH
82- MR 4 55.50 1n