HomeMy Public PortalAbout10534 LIVE OAK AVE_Sewer__ 7SA
- FOR PERMIT
S&642DE-66it-'IS' APPLICATION -
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles _ BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ee jr42
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT O FILL IN - CROSS ST.
DESCRIPTION LOT NO f OWNER
�
BLOCK •TRACT MAIL. Z ADDRESS
NO.OF
SIZE OF LOT 10,0 NOW ON LOTS CITY / /t e! TEL NO
USE OF DISTRICT NO. GROUP MAP
BUILDINGS t' G BK PG
CONTRACTOR _ / Jr
`
ADDRESS CONNECTION DATA
, / � tg
1�_ STATION DEPTH
CITY /P e� EL. NO. al If 'V� MANHOLE REFERENCE / 415=R
ErSTATE e LOWER
REGISTRATION NO. B® ❑ COUNTY
NO. DESCRIRTION OF WORK FEE
TYP OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO -.D Y. CURB P L M.L.TO P.L.
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR 21
PITS AND/OR DRAINFIELD Q $3 00 J
OVERFLOW SEEPAGE PIT, DRAINFIELDP NO
CO. IMP NO. �r JOB NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT N0. '
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL -
- CHARGES
CONNECTION CHARGE FEE
OWNER'SPERMIT 1 00
L REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR•S•SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED OR ` DAY F v w 19� CONNECT A WORK"(
OWNER OR � BUILDING ORR WORKS
OWNERS AGENT_ _�2 /1 iC-OI�C.t/C
„ SEPTIC TANK,'SEEP,PIT(S)
ADDRESS-±_'_"4 AND/OR�*--+• '�%� AND/OR DRALNFIELD
I
HEREBY, ACKNOWLEDGE THATSI 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELCOUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I M J E LEG OWNER OF THE ABOVE
DESCRIBED RESIDENTIA ROP TY BACKFILL SEPTIC TANKS❑
SIGNATURE + SEEP PIT(S) ❑ CESSPOOLS[I
OF PERMITTEE ✓+
JOHN A LAMBIE, COUNTY ENGINEER ALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
GASH -
F 4 4 ? 3 SEP
4'1 � A 6-50 M
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