HomeMy Public PortalAbout10532 LIVE OAK AVE_Sewer__ APPLICAT�ON FOR PERMIT
ceeos a-sa COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRE SG A /-
IOHN A. LAMBIE, Count Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY Te 1 G
FOR APPLICANT TO FILL IN, NEAREST
CROSS ST. I-P 1.
LEGALOWNER
DESCRIPTION -OT N0.
AI
MAI L
BLOCK TRACT ADDRESS /O nt
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO
USE
—BUILDINGS RP IV eDISTRICT NO. GROUP BK MAP PG PROCESSED BY
S 1 .� '
_
CONTRACTOR S
ADDRESS ! d .� /e u� E, CONNECTION ATA
CITY �c`s TEL.NO. �� �'7�4,*- STATION DEPTH
g STATE MANHOLE REFE EN _ UPPER
REGISTRATION NO. J Z9 / r COUNTY LOWER
NO. DESCRIPTION OF WORK FEE !
HOUSE SEWER CONNECTING TO v� 7, '
PUBLIC SEWER Co) $3.00 TYPE OF CONNECTION LENGTH FROM
P ITS AND/OR DRAINFGELDT OR @ $3 00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN CESSPOOL DRYWELL - @ $2 00
HOUSE SEWER CONNECTING TO P C.NO. _
PRIVATE DISPOSAL SYSTEM @ $100 CO IMP.N0. JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO. D PERMIT NO.
WORK TO HOUSE SEWER @ $1 00
AEW ER OR DISPOSAL SYSTEM IR OR ABANDON HOUSE @ $1 00 STATE ENCROACH
PERMIT NO
INDUSTRIAL
WASTE AP OVAL
CHARGES
OWNER'S PERMIT $ 2 'OD CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 3" REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEREINCON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. _T
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL jCOUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 1 AM TH LEG OWNER OF THE ABOVE
DESCRIBED RESIDENTIA OPE BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS'❑
OF PERMITTEEr
OF VALIDATION ROBERT A. WOOD
cK, M.o. CASH SUPERVISING MECHANICAL ENGINEER
' 5 6.5 W9 • JAN 26 1 0 A 3_00 19