HomeMy Public PortalAbout6323 LIVIA AVE_Sewer__ 50 INSERTS
CE808 6-60
I•
76A642D APPLICATION OR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDADDRESG �3 \!
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITY C
FOR APPLICANT TO FILL IN CROSS s. ,'�_ rT
LEGAL til �'-' s -tar; f1
DESCRIPTION LOT NO. OWNER ' l h.-. .."+I ti_ -.�-> 1c F.�
BLOCK TRACT //,J MAIL
r.J ! ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
BUI DINGS _`� — C DISTRICT N0. GROUP BK MAP PG PROCESSED BY
CONTRACTOR
ADDRESS CONNECTION DATA
CITY _ C.,. TEL.N0. .. G STATION ® 'T� C DEPTH
REGISTRATION NO. 13 COUNTY TATE MANHOLE REFERENCE 7 e (. LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 OO TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
CO. IMP. NO. O JOB NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 W
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. V
ALTER. REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
_ SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. O
INDUSTRIAL U
_WASTE APPROVAL PW.
CHARGES N
OWNERS PERMIT 5 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE I IQO REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW
SIGNED THI 1 DAY OF 19_ NEW HOUSE SEWER
OWNER OR '' %� CONNECT ADDITIONAL
OWNERS/�F+ENT —��-�"�=�T >�` 7-:o i'' BUILDING OR WORK
i
ADDRESS - - .�::. SEPTIC TANK,SEEP.PIT(S)
_AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE AT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE 'ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 AM THE LEGAL 0 NER OF THE ABOV
DESCRIBED RESIDENTIAL PROP .Dy/ d BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PITS) ❑ CESSPOOLS ❑
OF PERMITTEE ���((ILLLGGG N
OF --V}ALIDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
L�