HomeMy Public PortalAbout10662 LORA ST_Sewer__ "°Aga APPLICATION ICOR PERMIT
.E80B-&•$$•8 -
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS r' Cj 1?X
JOHN A. LAbIBIE. Coualy Engineer
CASSATr D. GRIL FIN.Supt of Building LOCALITY PIL_p
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. J.✓ OWNER
BLOCKMAIL
TRACT ADDRESS
' 44tit
NO.OF BLDGS. f
SIZE OF LOT � NOW ON LO_T CITY TEL.NO.
OF
_.
BUILDINGS .,.,,.- r..,y,. 1 DISTRICT NO, GROUP MAP PROCESSED 0
CONTRACTOR
BK PG ✓
N
ADDRESS - So. fialdmda Avenue CONNECTION DATA
CITYLA. STATION DEPTH
,}} y ,,J/ STATE UPPER
REGISTRATION N0. f�_l 'N� 1.. COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE --= - LOWER
HOUSE SEWER CONNECTING TO . 4
AUBLCC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR. TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $8.00 Y. CURB. P.L. M.L.TO P.L. -
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN.,CESSPOOL,DRY'WL`LL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. NO,
PRIVATE DISPOSAL SYSTEM @ $_3.00 CO.IMP.NO. - .JOB NO. -
CONNECT ADDITIONAL BLDG.012 TRUNK.PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM a $1.00 _PERMIT NO.
v
WASTE APPROVAL
CHARGES
OW14EWS PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL, FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE `INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. I ��
SIGNED THIS DAY OF I9& NEW HOUSE SEWER
OWNER OR i) CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR LVO?K
SEPTIC TANK,SEEP,PIT(s)
ADDRESS - AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[I 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
I 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 LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT.M4. CRO ERTY. BACKFILL SEPTIC TANKS [3SIGNATURE
SEEP.PIT(S) Ejj CESSPOOLS❑
A r r r
OF AERMI7TEE
BF - VALIDATION ROBERT A.WOOD
CK. R.0. CASH SUPERVISING MECHANICAL ENGINEER
X,>
r'� I