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Home My Public Portal About9655 LIVE OAK AVE_Sewer__ '/� F,� .11. /.fin 11 Fes' ^ h-�, h'��/�7 76A6420 'A11 P `L��CAT�©I!v FOR 11 Il' EIll1II.VII�T S&E-663 11.55 DIVISIONOF BUILDING AND SAFETY SEWER-SEWAGE D OSPOSAL Deportment of County Engineer County of Los Angeles Bu1LDINcs �� _ JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN SUPT OF EIUILDING LOCALITY �jy� //6 � FOR APPLICANT TO FILL IN CROSS ST. LEGALd �� DESCRIPTION LOT NO,� OWNERMAIL - BLOCK TRACT�._, !9's 49, AD RESS NO. OF BLDGS. CITY - TEL. N0, SIZE OF LOT I NOW ON LOT USE OF DISTRICT BUILDINGS . GROUP MAPBK P' /7 - CONTRACTOR-0a. ��•��/.�l ale fl /: "'�- �G n ADORE s ,�� CONNECTION DATA �- STATION /VYDEPTH CITI � EL. NO. 4 MANHOLE REFERENCE STATE r® .5A LOWER' I REGISTRATION NO. ?�� ❑ COUNTY r NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO .Y_ CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR ' PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD .,.7 P. C: NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE a $2.00 CO. IMP. NO. /30 0 JOB NO. a HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM a $I.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 , I HAVE AT THIS DATE A CONTRACT WITH THE HEREINNAMED CON- APPROVALS DATE INSPECTO •S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING / TO THE PUBLIC SEWER. ` " NEW HOUSE SEWER r� SIGNED THIS DAY OF 19� CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT - SEPTIC TANK,,SEEP„PIT(S) ADDRESS AND/OR DRAINFIELD I 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 PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM 7' HEREBY, CERTIFY THAT I AM PROPERLY REGISTERED AND/OR AND DISCONNECT PLUG LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HO PLUGUSE D CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE. ER DESCRIBED RESIDENTI OPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE A ,- SEEP.PIT(S) ❑ CESSPOOLS El OF PERMITTEE /� �� JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK. M. O. C-A-IH,.✓y l2 69 .6 ''SEP 2 6 4 45 0 � .