HomeMy Public PortalAbout10634 1/2 LIVE OAK AVE_Sewer__ r
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5 a 3 11.33 APPLICATION FOR PERMIT
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DIVISION OF.BUILDING AND SAFETY SEWER—SEWAG DISPOSAL iY
Department of County Engineer
County of Los Angeles LADOR:�DING
JOHN A LAMBIE, COUNTY ENGINEER CASSATT D GRIFFIN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN ' CROSS ST. G�l�tio-c
LEGALPi` r OWNER
DESCRIPTION LOT NO Zp.� �lY�f� l� 7l/�
MAIL -
BLOCK TRACT ADDRESS
SIZE OF LOT NO OF BLDGS CITY TEL. NO. ,5
NOW N LOT
USE LOF
BUIDINGS DISTRICT N0. _ GROUP BK MAP PG
CONTRACTOR
ADDRESS 0 CONNECTION DATA
�y STATION DEPTH
CITY TEL. N0, C./ Y Q
MANHOLE REFERENCE ./ d UPPER
( STATE �
REGISTRATION NO J COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 50ISD
Y• CURB P L M.L TO P.L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP. NO JOB NO
HOUSE SEWER CONNECTING TO y--. •yJ
PRIVATE DISPOSAL SYSTEM @.$1 00 TRUNK PERMIT NO. ROAD PERMIT N0.,,},:
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 PERMIT s 1 Oo
AUTHORIZATION 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 ./
TO THE PUBLIC SEW R NEW HOUSE SEWER
SIGNED THIS DAY OF _19�L1L CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT
gyp_ SEPTIC TANK,SEEP,PITS)
ADDRESS 1A-�L-v ' �•-`�' ` AND/OR DRAINFIELD
I HEREBY 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
IHEREBY 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 ABOVE
DESCRIBED RESIDENTIAL PROPERTY �- SEEPS
BACKFILL
SEPTIC
CESNKSCI El
���,�
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
C_AC,o 3Y CASH ���
7 4 7.5 0