HomeMy Public PortalAbout9508 LIVE OAK AVE_Sewer__ D
S&E-683 11•SS APPLICATION FOR PERMIT 1
8&E-8 .
DIVISION 'OF'BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER- ADDRESS
®' CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY ' -
FOR APPIiIC NT TO FAL CNRoss ST. 41P-1 ti 12
LEGAL O'
06
DESCRIPTION LO NO ,B. OWNER
n� MAIL
BLOCK TRACT ,0�.� ADDRESS
NO OF BLDGS
SIZE OF LOT ��c5.'aD NOW ON LOT oy CITY TEL NO.
USE OF C
BUILDINGS ' DISTRICT NO. GROUP I MAP
BK •PG
CONTRACT
CONNECTION DATA
ADDRESS Cf�D _
CITY - TEL. NO. ZSTATfON
da51,910 MANHOLE REFERENCE �� DEPTH UPPER j
REGISTRATION NO _ ❑:1 STATE'
-
NO DESCRIPTION OF WORK FEE
TYPE OF C ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO _�'A Y. Rn
P.L M L TO P L.
PUBLIC SEWER @ $3 50 (i V
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. N0. '
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO, IMP. NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO � L,
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS _ DATE INS p ECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �� p
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS D Y 19
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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 i-
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM -�
IICHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T11E (AL.OWNER O,f THE ABOVE
DESCRIBED RESIDENT PROP 97,
BACKFILL SEPTIC TANKS❑ '
SIGNATURE :r ,,(�;y>'/� �' SEEP.PITS) ❑ CESSPOOLS❑
OF PERMITTE
JOHN A. LAMBIE, COUNTY ENGINEEFY VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
N 0 CASH
1�� �6 2 0 1 9 4 4.5 C�-