HomeMy Public PortalAbout10221 LOWER AZUSA RD_Sewer__ 78A842D '
CES 8.8:$a APPLICATION FOR PERMIT
•COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL, +
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ate®
ADDRESS 10 Of
JOHN A. LAMBIE, County Engineer'
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL d y
BLOCK TRACT ADDRESS
N0.OF^BLOT 0
SIZE OF LOT NOW ON LOT CITY TEL.N0.
USE OF
BUILDINGS DISTRICT NO.j GROUP I MAP PROCESSED BY
BIS PG
CONTRACTOR Able Cons tro. ��- _-L.
ADDRESS 225 We Bryant Rd. CONNECTION DATA
CITY F1 Monte TEL.NO. GI .8-6565 STATION DEPTH
STATE MANHOLE REFERENCE UPPE
REGISTRATION N0, 168 COUNTYdZ
NO. DESCRIPTION OF WORK FEE R'
a HOUSE SEWER CONNECTING TO
0 PUBLIC SEWER @ $3.00 TYPE OF CONNECTIOl�/ LENGTH FROM `f
SEPTIC TANK,SEEPAGE PIT OR Y. CURB /� I.L./` M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB N0, y i
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER
SEWER REPAIR OR ABANDON OR DISPOSAL SYSTEM HOUSE @ $' 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S HERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE _6 lee 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 TH DAY F 19_ NEW HOUSE SEWER
OWNER CONNECT ADDITIONAL
OWNERS AGENT A ° L •BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY KNOWLEDGE THAT I HAVE READ THIS APPLI ATION CESSPOOL❑ DRYWELL
AND STATE HAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS q!5vULATING 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 TH..g��T� I AM TH L L OWNER OF THE ABOVE -
DESCRIBED RESIDE f AL PROPE Y. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) [ICESSPOOLS❑
OF PERMITT
OF - VALIDATION - ROBERT A.WOOD ._
SUPERVISING MECHANICAL ENGINEER 1
CK.
M.O. CASH -. t
.Ivo -' `& 11 .0 A 5.00