HomeMy Public PortalAbout9916 MILOANN ST_Sewer__ 5&E-6b8�,1.55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS_ --•-a
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
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FADDRESSO'
OR APPLICANT TO FILL IN _ CROSS ST. c _
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TION LOT NO,
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-DESCRIPTION_
MAIL
TR ACT �f�
r NO.OF BLDGS.-
LOT f NOW ON LOT
CITY TEL. NO.
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SIZE s
DISTRICT N�Q„ GROUP MAP
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4, 4 - � C®NNEGTYON DATA
i-- J= TEL 0.' 1 $ + _ TION DEPTH- vG( -� MANHOLE REFERENCE, UPPER
STATE, LOR
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REGISTRATION N0,�� �" � t ❑ COUNIY '+ ,p r {�s�,- - ''. - R
No. DESCRIPTICEN OF WORK FEE
HOUSE SEWER CONNECTING TO
TYPE OF CONNECTION LENGTH FROM
-
-1 PUBLIC SEWER @ ?yY. CURB P.L. TO.3,56 - - - .y P,L.
_--� SEPTIC TANK,SEEPAGE PIT OR
PIIS A_N_D/OR DRAINFIE.LD i $3.,00 - � T "'•
OVERFLOW SEEPAGE PIT,DRAINF!ELD V P. C. NO.
EXTN ,C_ESSPOOL,DRYW_EL_L,MANHOLE ((u�. $G,O� CO. IMP, NO.. JOB NO. _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @1 $1,00 ( TRUNK.PERMIT NO. - ROAD PERMIT NO.6 -
^i CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
WORK T_O HOUSE SEVER _!n� $t.G6 ! PERMIT NO _zw - _
I ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL n
_— SEWER OR DiSPGSA.L SYSTEM, .A$7.06 _ WASTE APPROY
-- SA S --
--------- ,rv EHARGES - c�5 J
__. _ CONNECTION CHARGE FEE
OWNER'S PERMIT $ — -1 -O0 — ----
--I_^_ REIMBURSEMENT FEE
AUTHORIZATION. TOTAL FEE �
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HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. .-_____APPROVALS I�..DATE IINSPECTOR'S SIGNATURE
__.__.___`___..._.._-__�.___
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING. '
TO TEE PUBLIC SEVVER,. NEW HOUSE SEWER
SIGNED THIS DAY OF —19__ ^CONNECT ADDITIONAL -___--
OWNER OR - BUILDING OR'dORK
OWNERS AGENT----.
-- SEPTIC TANK,SEEP.,PIT(S
ADDRESS - AND/OR DRAINFIELD !
_--.L � - -- ALTER,REPAIR,
D DISPOSAL S SYSTEM
I HEREBY ACKNOWLEDGE THAT 1 PAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _—
L4'dTH ALL COUNTY ORDLNAHCES. AND STATE LAWS PEGllLATiNG. -
PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT d AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
1
LICENSED AS REC,UIRED BY LOS ANGELES COUNTY AND STATE OF DICOABANDON CT PTE SEWER � I
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE -- -- ----
SIGNATURE -----I----------�
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC (AN KS ri
.._SEEP.PII-15—) '"1 "ESSPGOLS u - - {----._ _.----
_ _..--- - - ------- ----'-------
OF PERMITTEE _
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JOHN A. LLAMBIE, COUNTY ENGINEER LIIIATI�3 ROB R A: WOOD,CHIEF PI_BG. INSPECTOR
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