HomeMy Public PortalAbout9540 LIVE OAK AVE_Sewer__ 04-A
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CE9D8.6->ia APPLIC TIOMFOR PERMI '
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEERBUILDINfJ
BUILDING AND SAFETY DIVISION ADLD
DRESSG �:� ewk
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL'IN CROSS ST.
LEGAL - �- -
DESCRIPTION LOT NO. Y` _ OWNER
MAIL-
BLOCK TRACT ADORE
i NO.OF BLDG!?
X
SIZE OF LOT n e NOW ON LOT CITY EL.N0.
USE OF
BUILDINGS DISTRICT NO. GROUPI
MAPROCESSED'BPG Y
CONTRACTOR
ADDRESS �d�� �/ CONNECTION DATA w
CITY TEL. 0. �r rp rdCOUNTY
STATION / DEPTH
MANHOLE REFERENCE }UPPER
REGISTRATION NO. 6 3 No. DESCRIPTIO F WORK FEE
oloffOUSE SEWER CONNECTING TO
IV PUBLIC SEWER @ $3.00 TYPE OF TION _LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR Y. CUR P.L. M L.TO P.L.
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD - -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO 13 P.C. N0.
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
DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL e2
CHARGES /a4.4
OWNERS- PERMIT S 2 DO CONNECTION CHARGE FEE
-AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN.NAMED CON. APPROVALSM DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THISAY OF Ig_ NEW HOUSE SEWER
OWNER OR r CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
t SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE 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
I 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
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE • SEEP.PIT(S ElCESSPOOLS❑
OF PERMITTE -�
OF /--*AMATION ROBERT A.WOOD
cR. U.o. CASH SUPERVISING MECHANICAL ENGINEER
?8 1 A' 5.00