HomeMy Public PortalAbout9202 LIVE OAK AVE_Sewer__ 5a,E-6 8,1.86 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE -DISPOSAL -
Deportment of County Engineer
County of Los Angeles BUILDING D
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
9
FOR APPLICANT TO 'FILL N CROSS sT�
LEGAL - - -
DESCRIPTION LOT NO ® '. ✓fJ OWNER
MAIL
BLOCK - TRACT ADDRESSNO OF BLDGS CITY TEL. NO
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS � - � I B PG
CONTRACTOR /•e roti
ADDRESS A.4
•CONNECTION DATA
`
CITY 9 STAT IO DEPTH
r TEL. N0. MANHOLE REFERENCE
TATE • 1 LOWER
REGISTRATION NO. fp ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ` TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 50 6t� X CURB P L M TOP -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELDC. N0.
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO. I P. NO t7 OB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.Y—
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER Q $1 00 6 O PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER Ojh DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
S6 �^
OWNERS PERMIT 00 REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE C
APPROVALS DATE INSPECTOR'S SIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 4
TO THE-PUBLIC SEWER, NEW HOUSE SEWER i�)1Xr �4j '
SIGNED THIS DAY Or, 19 CONNECT ADDITIONAL Y '
OWNER OR _ l BUILDING OR WORK
OWNERS AGENT SEPTICTANK,SEEP,PIT(S)
ADDRESS 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY OS ANGELELE 0
0 UNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I THE G NER OF THE ABOVE
DESCRIBED RESIDENTIAL OP BACKFILL SEPTIC TANKS CI nn
SEEP PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE -
�i .
JOHN A LAMBIE. Co TY ENGINEER VALIDATION ROBERT A. WOODeCWN SpEpIOR
CK. E! 0 CASH ��
AP 5 1 2 � u; PTR 15 1 0 A 6.00