HomeMy Public PortalAbout10219 LOWER AZUSA RD_Sewer__ APPLICATION FOR PERMIT
canoe-s-Ss ,,COUNTY OF LOS ANGELES .1.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAIVIBIE, County Fmgiaeer ADDRESS-
CASSATT D. GRIFFIN, Sup'1 of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL INJ i CROSS ST.
LEGAL
DESCRIPTION LOT NO. .•I.T-
/ OWNER
BLOCK TRACT i MAIL
ADDRESS
NO.OF BLDGS. a ��
SIZE OF LOT NOW ON LOT CITY TEL.NO. PAe7-,e'A 49
USE OF ,
BUILDINGS ✓C Q, DISTRICT NO. GROUP MAP PROCESSED BY
BK � P6
i CONTRACTOR Able Constr. - QJ 7—1
ADDRESS 225 Wo Bryant Rd, CONNECTION DATK
CITY ' El Monte TEL.NO. GI 8 STATION ' DEPTH_. 9
/p STATE Sr] MANHOLE REFERENCE Y ,® UPPER
REGISTRATION NO. ZOOA COUNTY
No. DESCRIPTION 0- ORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM r+ C
SEPTIC TANK,SEEPAGE PIT OR Y. CURB L. M.L.TO P.L. /
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOC.
NO. �-
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR - TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00- PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
n OVPNER'S PERMIT $ 2 00 CONNECTION CHARGE.FEE
AUTHORIZATION TOTAL FEE 51 V), 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.
SIGNED THISAY OR- 19�
(" NEW HOUSE SEWER
OWNER OR ' ✓ CONNECT ADDITIONAL
OWNERS AGENT' ? "' EA I BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
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 THA I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE -AL PRO BACKFILL SEPTIC TANKS CESSPOOLS El
SEEP. PIT(S)OF PERMITTE
OILT0.
TION ROBERT A.WOOD
CASH SUPERVISING MECHANICAL ENGINEER
FaAIP
:�,.-I 9 6 SEP �4K