HomeMy Public PortalAbout9459 LIVE OAK AVE_Sewer__ � � I
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76A APPLICATION FOR PERMIT
76A 6
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING L�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUP T OF BUILDING
LOCALITY
F R APPLICANT TO FILL IN NEAREST
CROSS ST
(PRINT OR TYPE ONLY)
LEGAL
DESCRIPTION LOT NO �7�/ �J OWNER / /1(
�i ! G �' MAIL .E7w
BLOCK TRACT � ADDRESS
OF BLDGS
SIZE OF LOT O NOW ON LOT CITY 6 /� EL NO
USE OF
BUILDINGS �t DISTRICT NO GROUP ('LASS MAP ESSED BY
BK PG
�y^l
CONTRACTOR �� / '•, L /
ADDRESS K �� O /CO.�NyyNECTION DATA
CITY (� L NO STATION 2�/ / DEPTH /
STATE LIG MANHOLE REFERENCE 77
f /, / L �
LICENSE NO GLASS /
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TOY CURB P L ML TOPIL
PUBLIC SEWER a S5 00
SEPTIC TANK SEEPAGE PIT OR J P C NO
PITS AND/OR DRAINFIELD @ $1000 CO IMP NO / JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300 /93 dO
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIYLR [AS[M[NT RECORD INSTR NO DATE
WORK TO HOUSE SEWER $300 V
OVERFLOW SEEPAGE PIT DRAINFIELD ce
EXTN CESSPOOL DRYWELL MANHOLE @ $500
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING 0
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT V
PERMIT NO lJ.l
a
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT sIV 00 CHARGES
AUTHOREZATIONI TOTAL FEE / CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSP CTOR S SI ATU RE
SIGNED THIS DAY OF 19 jv J
OWNER OR NEW HOUSE SEWER CJ
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEEP PIT(S)
AND�OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Cl
AND SEWERS CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE SCRIBED RESIDENTIAL ROPSATY ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMfTTEE SEEP
PIT(S) ❑ CESSPOOLS ❑
VALIDATION JACK R. ALLEN
CASH SUPERVISING MECHANICAL ENGINEER
CK �M O
A0 2 9 0 1."•= WI 1 9 1 0 xD 1 0.0 ON