HomeMy Public PortalAbout9446 LIVE OAK AVE_Sewer__ 76A64ED APPLICATION FO • PERMIT
r
ceeoe 11-577COUNTY OF LOS ANGELES
- SEV!/EF_t—SElli/AGeE {DISP_OSi4L ,' ;
DEPARTMENT OF COUNTY ENGINEER /
BUILDING AND SAFETY DIVISION BUILDING
-
_ County F� >
1 C IASSATT D. GRIFFIN, Supof Building -
LOCALITY
FOR APPLICANT TO FII.L IN ceOSS ST -'
LEGAL �,+ " 2 '40#�T �Q b OWNER
DESCRIPTION LOT N0. /
BLOCK TRACT/ �/� _zP7' '•/ 1-/J 0 ADDRESS L,kd' �`{,/ '•.�' }
�I n/NO OF BLDGS, pa / ,, �y r _
SIZE OF LOT J 1D NOW ON LOT r CJ'�I/ •CITY' Y//.- V TEL.,N0. r
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR �� J 3' STATION
ADDRESS R-' . CONNECTION DATA
L.NO. !'f 71 DEPTH & '
v�. �rS'{ATE MANHOLE REFERENCE UPPER
REGISTRATION NO. 6 J d COUNTY /,
NO. DESCRIPTION OF WORK FEE �� dr bb ^ r
- HOUSE SEWER CONNECTING-TO
PUBLIC SEWER @ $3 50 •"�
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECT ON LENGTH FROM a,
ITS AND/OR DRAINFIELD @ $3 00 Y. CURB P.L. M.L.TO P L. a,J
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO yy
PRIVATE DISPOSAL SYSTEM @ $1.00 CO IMP.NO. .7 JOB N0O
CONNECT ADDITIONAL BLDG.OR -
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT NO. ROAD PERMIT N0. ea A
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM' @ $1.00 STATE ENCROACHMENT
PERMIT NO. '
.-INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 1 000 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FES .S REIMBURSEMENT FEE
NAMED CON.
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT WITH IING DWELLING APPROVALS DATE INSPECT GNATURE
TO THE PUBLIC SEWER.
SIGNED THIS�DAY OF - �� �~ 19 NEW HOUSE SEWER l�
OWNER- OR --��c1' -� - / - -- -- rCONNECT ADDITIONAL
OWNERS AGENT—/� C,/19 fT g .!!/ - BUILDING OR WORK -
ADDRESS- / s�=*✓G-i'?'-%'%' -/i` ". - -SEPTIC TANK;SEEP;PIT(S),-- - •-- - __ - -
'AND/OR DRAINFIELD - -
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE-THAT THE_ABOVE,IS CORRECT-AND AGREE.TO-COMPLY CESSPOOL-El- DRYWEL-L El--^
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM- - - - •---- - -
I-HEREBY-CERTIFY'THAT-'1_ AM'PROPERLY REGISTERED"AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT,I AM- T,HE_LEGAL OWNER,_OF_.THE ABOVE. ABANDON HOUSE SEWER
DESCRIBEDRESIDENTI PROPERTY. ^ • BACKFILL-SEPTIC TANKS [:1
SIGNATURE SEEP PIT(S) [I CESSPOOLS
OF
SIGNATURE
TE ��OF `_ ALIDATION..7ROBERT-W WOOD_
CK _ _d o Wile - SUPERVISING MECHANICAL ENGINEER -
_ LAC 4-6 1-9 T SEP 1 Q-1• -A 4-,5 0 In - --- -