HomeMy Public PortalAbout10670 LORA ST_Sewer__ f
808' . APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DI`PISION BUILDING ;
ADDRESS
JOHN A. LAMBIE, County Engineer -��,--
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. z
LEGAL
DESCRIPTION LOT NO. f--' OWNER
BLOCK TRACT -„�;, `y', MAIL ADDRESS �-
N0.OF BLDGS. I ..� �_..
_SIZE OF LOT '{fir =. NOW ON LOT ^ - CITY B/ TEL. h0, � r �r-
USE OF r a
BUILDINGS t' DISTRICT N0, GROUP MAP PROCESSED BY
PC-
CONTRACTOR,.. - -...
ADDRESS CONNECTION DATA
CITY w ""f-NO, STATION DEPTH
❑ STATE MANHOLE REFERENCE ;aP
REGISTRATION N0, — -'-- - ❑ COUNTY - Lr)WER•}
NO. DESCRIPT10N CIF'INORIt FEE --_-
HOUSE SEWER CONNECTING TO t: •. :..�<" -
PUBLIC SEWER @ $3.00 " TYPE OFLENGTH FROM ~
SEPTIC TANK.SEEPAGE PIT OR Y, .CU ;.ION RB P.L. M.L.TO P.L. "
PITS AND/OR DRAINFILLD @ $3.00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD - -
EXTN...CE:SSP'JOL.. 6RYWELI. @ $2.00
HOi7SE SEWER CONNECTING TO 1 P,C.NO.
PRIVATE DISPOSAL SYSTEM @ $1,00 CO.IMP, NO. J c - JOB N0,
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO r
WORK TO HOUSE SEWER @ $1.00 -
AI-TER,REPAIR C,R ABANDON HOUSE STATE ENCROACHMENT
__St
E11 R 0R Di1POSAi_I_,
11 @ $7.00 PERMIT NO.
INDUSTRIAL
_WASTE APPROVAL
_ CHARGES
OWNER'S PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE �'';'� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.r - -
SIGNED THIS DAY OF � `^ t9�,�. _ NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL,
, ):' . f —�
OWNERS AGENT ' .s BUI!_DING OR WORK t
SEPTIC TANK,SEEP.PITS)
---- - -- AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
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 DISCONNEHOUSE CT
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT+AL PROPERTY, - BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS "
OF PERMITTE
VALIDATION ROBERT A. WOOD
CX; M.0 H SUPERVISING MECHANICAL ENGINEER
:a
✓.x?° '' J;'y,? a✓ a c'''„
J 1,.