HomeMy Public PortalAbout9557 LOWER AZUSA RD_Sewer__ 78A6APPLICATION FOR PERMIT
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DMSION OF BUMDMG AND SAFETY SEWER-SEWAGE D 1 SPOSA L
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T of BUILDING
LOCALITY
FOR APpI4CMTTO NEAREST /
LEGAL ' +
DESCRIPTION LOT NO A OWNER
MAIL - o
BLOCK - TRACT ADDRESS
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF `
BUILDINGS Opt DISTRICT NO GROUP I MAP
� BK PG
CONTRACTOR
ADDRESS 001, 1
CONNECTION DATA
1 �
CITY TEL NO
STATION 2 + e DEPTH
'�
.� MANHOLE REFERENCE I UPPER
REGISTRATION NO L7 STATE I `
`�/ ❑ COUNTY
NO DESCRIPTION OF WORR FEE TYPE OF ION LENGTH FROM
HOUSE SEWER CONNECTING TO Y UR P L M L TOP I
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q S 3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO I v
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $100 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE a
OWNER'S PERT 1 00
AU�HOAIZATION TOTAL FEE REIMBURSEMENT FEE '
I HAVE AT THIS DATE A CONTRACT WITH THE REIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIB EXISTING DWELLING
TO THE PUBLIC SEW NEW HOUSE SEWER
SIGNED THI DAY O 1 CONNECT ADDITIONAL '
OWNER OR BUILDING OR WORK
OWNERS AGET
NT SEPTIC TANK,SEEP,PIS)
ADDRESS AND/OR DRAINFIELDO
I HERE Y ACKNWLEDGE THATI HAV READ THIS PLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRE T AND AGREE TO COMPLY
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 REQUIRE BY LOS ANGELES COUNTY AND STATE 0 p D HOUSE SEWER
C FORMA 0�THAT I A T LEGAL ER OF AB
DES R6lSIDENTI P A L SEPTIC TANKS❑
SIG r f f T(S) ❑ CESSPOOLS(
OF PERMITTEE '
JOHN A L AMBIE.COUNTY ENGINEER VALIDATION ROBERT A WOOD,CHIEF PLBG INSPECTOR
CK d 0 CA H J
F6,11 - 4 .'450 2 .
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