HomeMy Public PortalAbout9663 LIVE OAK AVE_Sewer__ 78A842D ; 4' P ��C(r'd N �® O FE R II V T
cesoe 849 COUNTY OF LOS ANGELES SEWER—SEWAGE DUSPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 9 BUILDING
ADDRESS
JOHN A. LAMBIE, Countg Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
k NEAREST
FOR'APPLICANT TO FILL IN cl:oss sr.
_ LEGAL /• J�� OWNER
DESCRIPTION LOT NO.
BLOCK TRACT J�/
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT- , CITY TEL. NO.
USE OF ,, u.e - ..•r,
BUILDINGS Aa DISTRICT NO. GROUP MAPPR CES ED BY
s B—K^ PG 9
CONTRACTOR u�`Ijj
v(/fi _
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ADDRESS CONNECTION DATA �J �
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CITY TEL.
8 STATION DEPTH
1 N0.
't`` STATE MANHOLE REFERENCE UPPERi
REGISTRATION N0. V3qq EtCOUNTY C. LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ^
PUBLIC SEWER @ $3.00 c- V TYPE'OFC09MECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR t� Y. CURB�I P.L. M.L.TO P.L. \J
PITS AND/OR DRAINFIELD @ $3.00 _
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
s<. HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR -7
"s
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. i /
ALTER,REPAIR
D13POSAL SYSTDEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL.
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 QD CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 1 00 REIMBURSEMENT FEE
Im I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTbR'S SIGNATURE
TO THE PUBLIC SE ER �-
p SIGNED THIS DAY OF 1 NEW HOUSE SEWER iG
�o OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS �-1 SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
LSTATE
EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER ORNG AND SEWERS. SEWAGE DISPOSAL SYSTEM
EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
D AS REQUIRED B LOSANGELE UNTY AND STATE OF AgpNDON,HOUSE SEWER
NIA OR THAT 1 THE GA - NER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
BED RESIDENTI L R PERTYURESEEP.PIT(S) ❑ CESSPOOLS ElRMITTE
'17
OF ALIDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
7609 ;Ir2✓ _ 5 . G .
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