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CE608.8 - APPLICATION FOR PERMITza'�,-Oleplos",/ceeoa•e-ae COUNTY OF LOS ANGELESSEWER=SEW
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN & LAMBIE, County Fmglnaar ADDRESS /^
CASSATf D. GRIFFIN. Supt o4 Building LOCALITY/
NEAREST.
FOR APPLICANT'TO FELL IN CRoss sr.
LEGAL2 OWNER
DESCRIPTION LOT N0.
BLOCK TRACT MAIL /�
ADDRESS L/
OF G -
SIZE OF LOT CITY TEL.NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP P CESS
BK P
CONTRALTO
ADDRESS r ro— CONNE TI N DATA -
CITY TEL. N0. A STATION _DEPTH -
STATE MANHOLE REFERENCE
REGI RATION N0. �^ COUNTY
No.
DESCRIPTION OF WORK FEE W
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTIONLENGTH FROM
PITS AND/OR DRAINFIELD Q $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD J
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2 00 D
HOUSE SEWER CONNECTING TO P. N0. de
PRIVATE DISPOSAL SYSTEM @ $1.00 MP.NO. -JO 0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1:00
ALTER,REPAIR OR ABANDON HOUSE• NCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.0 'PERMIT
INDUSTRIAL-
d(_d WASTE APPROVAL
CHARGES
OWNERS PERNIIT 2100 CONNECTION C GE FEE
AUTHORIZATION I TOTAL FEE REIMBUB86MENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DTE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF I9_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL ,
OWNERS AGENT y n BUILDING OR WORK
SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWEL'L❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTY TI AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIIFHA RED LOS ANVAks COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE GA OWNER OF THE ABOVE
DESCRIBED RE EDEN PROPER BACKFILL SEPTIC TANKS❑
SEEP. PITS CESSPOOLS❑
OF PERMITT
SIGNATURE ct-k .
1916 1
XMMATION ROBERT A.WOOD
K.p, emu SUPHRVISIN6 MECHANICAL FiNGINSfiR
L �O 8 1 8 4 JUN 18 1 0 .A 6.00