HomeMy Public PortalAbout10233 LOWER AZUSA RD_Sewer__ 788842
CE808 11 1-57 APPLICATION- FO. H tl' E 9 1►®1i/9 I 9 4✓w -
�
COUNTY OF.LOS ANGELES - � �/�AR-SEWAGE--'DlSP.0 An
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADD R S ' 1y
CASSATT D. GRIFFIN, Supt of Building CAL
FOR APPLICANT TO FILL IN CRO S -
LEGAL '
DESCRIPTION ' LOT NO..' OWNER
BLOCK. TRACT - MAIL
SIZE OF LOT �
� 22. .NOW ONBLOT.S Oa CITY-;Y,
USE OF
BUILDINGS '� �•-DISTRICTTN0.. ! , ROUP_ AP +/
CONTRACTOR f ,
ADDR- I.ACONNECTION DATA
CITY TEL.N0. , ;,• STATION DEPTH
S- STATE REGISTRATION NO. - ❑ COUNTY 'MANHOLE REFERENCE UPPER
LOWER
NO' DESCRIPTION OF WORK FEE �J
HOUSE SEWER CONNECTING TO �f,�
PUBLIC SEWER, @ $3&V
SEPTIC TANK,SEEPAGE PIT OR - y TYPE OF CONNECTION LENGTH FROM ,
PITS AND/OR DRAINFIELD @ $3.00* Y• CURB _ P.L. M.L,.TO P.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD .o
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 7 -
t HOUSE SEWER CONNECTING TO P.C.NO. ,
PRIVATE DISPOSAL SYSTEM _ @_ $1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR / I
W WORK TO HOUSE SEWER • @ $1.00. ( TR_UNK PERMIT NO: ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - - '
SEWER OR DISPOSAL SYSTEM @ $1.00' STATE ENCROAC T
PERMIT NO.
.. - _INDUSTRIAL
WASTE APPROVAL77
CHARGES
OWNER'S PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION
TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT-THIS•DATE A•CONTRACT WITH THE-HEREIN.-NAMED-CON-7 - -
TRACTOR:TO CONNECT'THE,_ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO.-THE PUBLIC SEWER
_ SIGNED THIS
DAY OF /Q164
19 NEW HOUSE SEWER b
OWNER -OR- ._-4 ...:..:..__�._.. ,. _.� ...... �........».. CONNECT-ADDITIONAIL^^ �........,.. -,�y,A� �',�"./......._. ,...-
OWNERS AGENT - BUILDING OR WORKADDRESS
., .-. ..SEP.TIC-TANK,-SEEP;-.PIT(S) - - -- _ - ^-
A'ND/OR"DR'A7NFIELD"
I HEREBY ACKNOWLEDGE THAT 1. HAVE READ THI APPLICATION - ._ + ,•� _T'
AND_STATE THAT-,THE,ABOVE_IS,_CORRECT-AND_AGREE..TO-.CO.MP•LY., --CESSPOOL-El:DRYWELL❑:^ -, - •�--
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR.
PLUMBING AND SEWERS. SEWAGE DPAIR,A EWER OR - - - -• ---
I-HEREBY'CERTIFY"THAT-F-A'M�"PROPERLY."REGISTERED' AND/OR SEWAGE
DISPOSUG AND -
EM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA_,ORTHAT._IMAM-THE.LEGAL_,OWNER, OF.- THE. ABOVE- ABA NOON HOUSE SEWER-,.--.
DESCRIBED RESID -AL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE _�^ u -:SEEP. PIT(S)'•❑ CESSPOOLS ❑
OF'PEBMITTE
VALIDATIO
. . .._ ..ROBERT.�A WOOD
CK. et.0 CASH SUPERVISING MECHANICAL,ENGINEER