Loading...
HomeMy Public PortalAbout6429 LOMA AVE_Sewer__ 8&E-868 11-35 APPLICATION' FOR PERMIT - -DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L Department of County Engineer County of Los-Angeles BUILDING ) / JOHN A LAMBIE, COUNTY ENGINEER ADDRESS i -_ice ® CASSATT D GRIFFIN, SUPT of BUILDING LOCALITY i FOR APPLICANT TO FILL-IN CROSS ST. LEGAL DESCRIPTION LOT NO X OWNER / e MAIL BLOCK TRACT- ADDRESS SIZE OF LOT/ X j4' NOWOON LOTS / CITY TEL NOUSOF BUILDINGS DISTRICT NO GROUP MAP B P CONTRACTOR A ;' - CONNEf TION DATA ADDRESS - r STATION 3 .52 / v / CITY C — TEL. N �L DEPTH MANHOLE REFERENCE � STATE LOWER- REGISTRATI011 N0. ❑ COUNTY _ NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Jam• PUBLIC SEWER @ $3 50 - P.L M L TO P,L SEPTIC TANK,SEEPAGE PIVOR PITS AND/OR DRAINFIELD @ $3 00 �..ii p C. NO. OVERFLOW SEEPAGE'PIT, DRAINFIELD EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO. IMP NO © JOB NO ` HOUSE SEWER CONNECTING TO - PRIVATE DISPOSAL SYSTEM @ �$1 00 TRUNK PERMIT NO ROAD PERMIT NO. CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $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 INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINGn TO THE PUBLIC SE NEW HOUSE SEWER SIGNED THIS —DAY OF 19 CONNECT ADDITIONAL OWNER OR - - BUILDING OR WORK - OWNERS AG NT SEPTIC TANK,SEEP,PIT(S) ADDRESS ��°i'� U AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 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 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER ' CA OR A OR THAT 1, AM THE LE�AL OWNER OF AB _ n,�� / DESCRIBE RESIDENTIAL P FPIT(s) Ej CESSPOLL SEPTIC TANKSOLS �,� 1�IrfJl/l�i�lef� SIGNATOR ,G � / OF PER T E JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR ` - CK. m 0. CASH - I - LI�Lo y 4 :)LF, Jury_�4 4 4.50 �