HomeMy Public PortalAbout9828 MILOANN ST_Sewer__ 'BAeq�° APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING
BUILDING AND SAFETY DIVISION
`v
JOHN A. LAMBIE, County Engineer ADDRESS
CIMATT D> GRIFFIN,Sup't of Building _LOCALITY ��� �
NEAREST
FOR APPLICANT TO FILL IN CROSS Sr.
LEGAL 3* d
OWNER -;p
–DESCRIPTION Lar NO. � t�;y
BLOCK TRACT T MAIL
AYt r = -j ADDRESS ,_S �(�
N0.OF BLDGS.
SIZE OF LOT NOW ON LOT ''. e
__ –CITY d " TEL.N(),
USE OF
BUILDINGS a > „Yy Itp DISTRICT N0. GROUP ASAP PROCESSED BY
- _ PK XPG__
CONTRACTOR s
ADDRESS c CONNECTION DATA
CITY TEL.N0, h. eSTATION ;' . DEPTH
y F� STATE MANHOLE REFERENCE
REGISTRATION N0. -,..�.) . 1, + COUNTY ,,�' �,, '
NO. I DESCRIPTION OF WORK FEE 'v r -. LOWER
HOUSE SEWER CONNECTING TO dr
PUBLIC SEWER @ $8.00
SEPTIC YANK,SEEPAGE PIT OR TYPE OF. TION LENGTH FROM g
Y. CURBS' P.L. M,L.TO P.L.
PITS AN.D,'OR DRAIN_FIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELd
EXTN.,CESSPOOL,DRYWELL;MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO r _ P.C. NO.
PRIVATE DISPOSAL SYSTEM Ctf $1.00 CO,IMP.NJOB NO.
TRUNK PERMIT
I CONNECT ADDITIONAL BLDG,OR
Nfl. ROAD PERMIT N0,
WORK TO HOUSE SEWER @' $5.00
ALTER. REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSALSYSTEMA $1.00 Pr_RMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVMEWS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 2 REIMBURSEMENT FEE
SHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATA 1N5PEG7 :NATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS—DAY OF 18— NEW HousE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS _! AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL® DRYWELL 0
WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANA/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE —
DESCRIBED RESIDENTIAL PROPERTY. Ufa" BACKFILL SEPTIC TANKS 0
SIGNATURE SEEP, PIT(S ❑ CESSPOOLS
OF PERMITTE
{
VALIDATION ROBERT A.WOOD
vy CK. M.0. CASH SUPERVISING MECHANICAL.ENGINEER