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HomeMy Public PortalAbout9376 LOWER AZUSA RD_Sewer__ BA848D D808 8-54 APPLICATION FOR PERMIT 7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL i■ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 10HN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION L07 N0. OWNER BLOCK TRACT MAIL _ ADDRESS , « - NO.OF BLDGS. SIZE OF LOT NOW ON LOT CIT s�>• h• fEL. N0, USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY JI B PG CONTRACTOR - ✓ '� -- s. - ADDRESS CONNECTION DATA CITYTEL.N0.r ` t — STATION DEPTH -.� r .j STATE MANHOLE REFERENCE - __...�. UPPER REGISTRATION NO. rr- p ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER C0 $3.00 _ TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. 'CURB - P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD .$3,00 OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL @ $2.00 _ HOUSE SEWER CONNECTING TO P.C.N0, PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO, JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1.00 ALTER,REPAIR OR ABANp11N HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT N0, INDUSTRIAL WASTE APPROVAL _ CHARGES ©WNIR'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED .EXISTING DWELLING APPROVALS DATE IINSPECTOR'SSIGNATURE TO THE PUBLIC SEWER. i SIGNED THIS__—�__,—DAY OF 18� NEW HOUSE SEWER OWNER OR ;f--�f ',yr ..�. . CONNECT ADDITIONAL OWNER AGENT ` BUILDING OR WORK ADDR: 9'S�''/�r �' .�-=- ;:.V' ..._- `� 4. - SEPTIC TANK,SEEP.PIT(S) _ 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 SEWAGE DIS PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OW'VER OF THE ABOVE DESCRIBED RESIDENTIA6� P,<ROPERTY. .-__ BACKFILL SEPTIC TANKS Ci SIGNATURE ` SEEP.PIT(S) E] CESSPOOLS OF P-ERMITTE1 f ; )a VALIDATION ROBERT A. WOOD d M.9. GASH SUPERVISING MECHANICAL ENGINEER 0 Im p 41-F W