HomeMy Public PortalAbout9710 LIVE OAK AVE_Sewer__ 76A642DD QPPLOCATOON FOR PERMOT � 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING d
JOHN'A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS, SUPT. OF BUILDING
LOCALITY
NEAREST
FOR APPLICANT TO FUL IN CROSS ST.
DESCRIPTION LOT NO. C �a�' y-ti-J Z OWNER
♦ MAIL y`
BLOCK TRACT lI ILTQ i� ADDRESS ( I Q Jz �' Ll� -
6' `J��- NO. OF BLDGS, �[r7
SIZE OF LOT NOW ON LOT CITY ClC Ce. TEL. NO. CJ
USE OF DISTRICT NO. GROUP MAP PR •ESSED BY
BUILDINGS
BK PGG/
CONTRACTOR tJ•^^� ✓r'`^"'�., D /J V
ADDRESS f(j cy�. _�J�C�[�G Ci�,Lt�a[/`7� /�y ,r COIVPIECTIOAI D1 m-ps
CITY —1 ,C,C/J- L!7 IYTEL. NO. .4 V • +2 ! Z STATION DEPTH
' STATE LIC MANHOL RENCE UPPER
LICENSE NO. CLASS EFELOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CO ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CUR P.L. M.L.TO P.L. '
PUBLIC SEWER $5.00
SEPTIC TANK.SEEPAGE P,IT OR P.C.NO.
PITS AND/OR DRAINFIELD SIO.00 CO.IMP. NO. B NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMI C_
PRIVATE DISPOSAL SYSTEM @ $3.00 C)
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIV[R [ASEM[NT RECORD.INSTR.NO. ATE U
WORK TO HOUSE SEWER @ S3.00 C=
OVERFLOW SEEPAGE PIT.DRAINFIELD c:)
EXTN.,CESSPOOL.DRYWELL.MANHOLE @ $5.00
HWY.OR ST.WIDENING V
L ABANDON HOUSE w
SEWER 53.00 STATE ENCROACHMENT �
PERMIT NO.
Ji
INDUSTRIAL
WASTE APPROVAL
OWNERRIS PERMIT s z o0 CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �/
TO THE PUBLIC SEWER. APPRO tlALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR �� n NEW HOUSE SEWER
OWNERS AGENT_ CONNECT ADDITIONAL
ADDRESS / • )v 'Q;: &eh L• C.,c t BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT A HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(5)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND�OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE /L���� BACKFILL SEPTIC TANKS ClOF PERMTTTEJ \ SEEP.PIT(S) ❑ CESSPOOLS O
IIM.O. CASH ALMAT'ION JACKR. ALLEN
SUPERVISING MECHANICAL ENGINEER
ALLEN(CK)
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