HomeMy Public PortalAbout9554 LIVE OAK AVE_Sewer__ �RQNT
E11B42D
CE808 8-59 APPLICATION FOR PERMIT
7
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESSG J Z d
JOHN A. LAMBIE, County Engineer l
CASSATT D. GRIFFIN, Supt of Ruilding LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL O
DESCRIPTION LOT NO OWNER +
BLOCK TRACT7 MAIL
�7 ADDRESS Z 1
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO.
USE DINGS HK DISTRICT NO. GROUP MAP PG PROCESSED
BUILDI
CONTRACTOR /g 40 Py -f f
c
ADDRESS f f' ec� w s tri�+ CONNECTION OATI
CITY TEL.NO,e!�Z � / STATION g DEPTH
, ATE MANHOLE REFERENCE
REGISTRATION N0. 41 T Z COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ��"1
PUBLIC SEWER @ $3 00 " vv TYPE OF CTION LENGTH FROM I
SEPTIC TANK,SEEPAGE PIT OR Y. C I P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL @ S2 00
HOUSE SEWER CONNECTING TO J P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO.IMP. NO [ JOB NO.
CONNECT ADDITIONAL BLDG OR TRUNKMIT NO. ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00 PERItW017Z
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO
INDUSTRIAL ,
WASTE APPROVAL '
CHARGES
OWNER'S PERMIT $ 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
A CONTRACT WITH THE HEREIN
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGAMED DWELLIONG APPROVALS ✓ DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. !l
SIGNED THIS DAY OF I9_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS 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 ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I 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 LEGA OW OF TH� ABOVE
DESCRIBED RESIDENTIAL P ERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PITS) ❑ CESSPOOLS ❑
OF PERMITTE S
®" VALIDATION ROBERT A. WOOD
CK U.p. CASH SUPERVISING MECHANICAL ENGINEER
r -,,, :s �,:�.4� .JAN 28 0 A 5.0 0