HomeMy Public PortalAbout9614 LIVE OAK AVE_Sewer__ 5&@ E-6D89 it-�3
8 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
,Department of County Engineer
County of Los Angeles BUILDING
JbHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® '�CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROS sr.
LEGAL ��q R
9 -
DESCRIPTION LOT NO. �--T.d_t OWNER
' /21 ci MAIL `
BLOCK TRACT [ ADDRESS A /�
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT S NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP I MAP
t.+ ♦ / PG
CONTRACTOR
{ I CONNECTION DATA
ADDRESS /Z�. S w ♦., �d 12C L y�
.� �- STATION T • (J DEPTH
CITY TEL. N0. ( J U S MANHOLE REFERENCE / UPPER
[]STATE
REGISTRATION NO. ❑ COUNTY _
NO. DESCRIPTION OF WORK FEE
'TYPE OF CONNECTIONLENGTH FROM s�
HOUSE SEWER CONNECTING TO Y. CURB P L. M.L.TO P.L.
PUBLIC SEWER @ $3 50 C)
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD / P. C. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO. ' 3O `� JOB NO.
HOUSE SEWER CONNECTING TO 1
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE, -
AUTHORIZATION TOTAL FEE v
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECT R.S_S,,lGNjTURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER D
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNEROR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY AC N JLEDGE THAT I HAVE READ.THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THA THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY-ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,-SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY"REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY,/LO
Y 'OS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I/ THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RES]DENTIAL/P OPERTY j BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS _
OF PERMITTEE �� -
JOHN A. LAMBIE. CO"Ty TY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG INSPECTOR
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