HomeMy Public PortalAbout6415 LIVIA AVE_Sewer__ 7GA6420 - APPLICATION,, FOR PERMIT ,
ceaoa-e-se COUNTY OF LOS ANGELES �.
:SEWER=SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DMSION BUILDING '
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building' LOCALITY i
NEAREST
FOR APPLICANT TO F I IN CROSS ST. -
LEGAL OWNER /
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT OW ON LOT CITY TEL.NO.
USE OF
BUILDINGS DISTRICT NO. " N $�
GROUP BK MAP'PG PROCESSED BY
CONTRACTOR
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ADDRESS CONNECTION DATA '
CITY TEL.N0. / d STATION 8� DEPTH
y� STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. �/ �� COUNTY LOWER
No. DESCRIPTION OFfWORK FEE,
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00
SEPTIC TgNK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE $2.00
HOUSE SEWER CONNECTING TO L ` P.C.NO.
`
PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP.NO. / / JOB NO.
CONNECT ODITION LOG,OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK T .00
ALTER, REPAIR OR ABANDON HOU STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM a $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWPNEWS PST $ 2 '00 -CON NECTION•CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNED ABOVE D IBED EXISTING DWELLING
TO THE PUBLIC S E
SIGNED THIS // nAY 0 11 NEW HOUSE SEWER D b
OWNER OR a CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK - _
SEPTIC TANK,SEEP,PIT(S)
ADORES 4 AND/OR DRAINFIELD
I HEREB ACKNOWLEDGE THAT I HAVE READ TH AP ICATI
AND STATE-THAT THE ABOVE IS CORRECT AND AG 0 COMP CESSPOOL❑ DRYWELL❑
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 ST TE OF "MDON HOUSE SEWER
CALIF IA OR THAT I M TH LEGAL 0 HER OF ABO _
DESCRIB ID IAL P B FILL SEPTIC TANKS❑ /
SIGNATUR f
IT(S) ❑ CESSPOOLS 12'
OF PERMITTE
®r VALIDATIO ROBERT A.WOOD
X.q. cag SUPERVISING MECHANICAL,ENGINEER
; ?r�7 2 8 5 ",0, 101 a A 6.00