HomeMy Public PortalAbout6463 LIVIA AVE_Sewer__ 82D
CE80APPLICATION FOR PERMIT
eaoa a-ss COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
I, x
JOHN A. LAMBIE, County Engineer ADDRE _
CASSATT D. GRIFFIN, Supt of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL OWNER i`
DESCRIPTION LOT NO.
BLOCK TRACT •-*7 js MAIL f `
f ADDRESS f _•�.
NO.OF BLDGS.
SIZE OF LOT ".NOW ON LOT CITY " TEL. MD.
USE OF / DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS -__ I BK PG
CONTRACTOR -. ..y �� �•� +
ADDRESS CONSECTION DATA
CITY ""� TEL.N0. STATION DEPTH
'J 'STS MANHOLE REFERENCE UPPER-
REGISTRATION NO. f ti%L,� COUNTY LOWER
No. DESCRIPTION OF W FEE
HOUSE
SEWER CONNECTING TO
PUBLIC ER@ $3.00
TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR --"^' Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
_ PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON SEWER OR DISPOSAL SYSTEM HOUSE STATE ENCROACHMENT
@ $1 00
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE L` REIMBURSEMENT FEE
1 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 SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS. SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED' BY LOS ANGELES COUNTY AND STATE 0(: ABANDON HOUSE SEWER
CALIFlSR'NJA OR THAT '1fp� LEGAL OWNER OF- THE A60bDESCRIBE R�,S Tl tY. BA. KFILL SEPTIC TANKS ❑
'1 ' SEEP. PITS) ❑ CESSPOOLS ❑SIGNATU dl fif. ���"'444�� t t• - `3 OF PERM TE
®F .'` VALIDATION - ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER