HomeMy Public PortalAbout10638 LIVE OAK AVE_Sewer__ 7
&E-669 11.58 APPLICATION! FOR PERMIT 1
8&E-86
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Dep=tment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS IU tri✓i1`� �U � �{(/'�i'
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY '7—NEAREST
FOR APPLICrkNT TO FILL IN CROSS ST.LEGAL
DESCRIPTION LOT N OWNER
MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS. CITY - TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF �q`�
BUILDING ..� V.I— •t DISTRIC I GROUP IMAP
K
CONTRACTOR �^,y �.�� IV
ADDRESS f. a /�� CONNECTION DATA
CITY S G TEL. NO,.,.+'/ /` STATION DEPTH
MANHOLE REFERENCE UPPER
STATE LO R
REGISTRATION NO. / ❑ COUNTY '
No DESCRIPTION OF WO FEE _
HOUSE SEWER CONNECTING'70 PE OF CONNECTION LEN H FROM
PY• CURB P L M TO P.L
UBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD . C. NO.
EXTN ,CESSPOOL,DRYWELL,MAN HOLE Q $2 00 CO. IMP N0. jw NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO. - 'ROAD P IT N0.
CONNECT ADDITIONAL BLDG OR STATE ENCROA ENT
7i WORK TO HOUSE SEWER Q $1 00 tNG Or7 PERMIT N
ALTER,REPAIR OR ABANDON HOUSE INDUST I
SEWER OR DISPOSAL SYSTEM Q $100 WASTE A 976
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
APPROVALS DATE INSPECTOR'SSIGNATU
TRACTOR TO CONNECT THE ABOVE DESCRIBED E)ISTING DWEL 3
TO THE PUBLIC SEWER NEW HOUSE SEWER -
SIGNED THIS-DAY OF / 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT ��,VVV SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE TH4T 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED S REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
C IFORN A OR THAT M THE LE AL OWNER OF THE ABpVE —
GSCRIB RESI�/TIA P�PER Y )� / BACKFILL SEPTIC TANKS❑
��,,,, / /J SEEP PITS) ❑ CESSPOOLS
RMIT EE `
JOHN A LAMBIE, COUNTY ENGINEER VALIDATIOROBERT A. WOOD, CHIEF PLBG INSPECTOR
CK 4 W3 US) SEP 19 10 A _ 3.0 0 A