HomeMy Public PortalAbout9226 LIVE OAK AVE_Sewer__ S&E-689311•DS
APPLICATION FOR PERMIT 1
S&E-6
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depaxtmeat of County Engineer
County of Los Angeles BUILDING
ADDRESS
JOHN A L•AMBIE, COUNTY ENGINEER
® CASSATT D GRIFFIN, SUP T OF BUILDING - LOCALITYNEAREST
A
FOR APPLICJANT TO FILL IN _CROSS ST.
LEGAL _OWNER I&DESCRIPTION LOT N0.
u MAIL
BLOCK TRACT '7 �. ADDRESS
N0. OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF _
BUILDINGS •v' DISTRICT NO. GROUP MAP
BK PIS
CONTRACTOR
_ CONNECTION DATA
ADDRESS �/�y71
STATION '0 DEPTH
CITY TEL. N0. jJ MANHOLE REFERENCE UPPER
•� �y STATE R
REGISTRATION NO V / COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CON ION LENGTH FROM
PUBLIC SEWER @ -$3 50 S
Y. CURB P L M L TO P.L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. N0.
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2_20 CO IMP. NO je JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO. ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR //�� STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 V PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
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 R•SSI INSPECTONATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING c
TO THE PUBLIC SEWER. NEW HOUSE SEWER ,.�--
SIGNED THIS ` DAY OF 19 CONNECT ADDITIONAL
OWNER ORl� I �'t�7f. _BUILDING OR WORK
OWNERS AGENT, /"Ih/?/�A�•.(/ / ///��� h�J
SEPTIC TANK,SEEP,PITS)
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 LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 .AMI THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) [ICESSPOOLS[I
OF PERMITTEE
Emma
JOHN A LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD,CHIEF PLBG. INSPECTOR
• CK.
M. 0 CASH
0
36•6 S APR 29 4A 5.5-Q ,R