HomeMy Public PortalAbout9934 MILOANN ST_Sewer__ 76AC42
3 a E-6r)63 11-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY,,"'
NEAREST
FOR APPLICANT TO FILL IN CROSS ST,/
LEGAL
DESCRIPTION LOT NO, OWNER
MAIL
BLOCK TRACT f
ADDRESS
-An—
NO OF BLDGS,
SIZE OF LOT NO�v ON LOT CM
�4 4TEL. N..(',,- L
USE OF 7
BUILDINGS --J-:,- - DISTRICT NO. UP MAP
BK PG
�C-ON_TR_A_CT C R
ADDRESS
CONNECTION DATA
10-1 4
ON
e7— ER__
3j DEPTH
TEL& STATi
CITY
MANHOLE REFERENCE
❑ STA F 141
REGISTRATION NO. ❑ COU
oxNO. DESCRIPTIO 10 W-eE E
I HOUSE SEWER CONNECTING TO TYPE OF =ECTION LENfTH FROM
PUBLIC SEWER @
y _.L.— M.L.TO P.L.
�
SEPTIC TANK,SEEPAGE PIT OR $3 50
PITS AND/OR DRAINFIELD
OVERFLOW INFI
W SEEPAGE PIT,DRAT ELDH P. C� NO.
TN.,CESSPOOL,DRYW ELL,MAN OLE @ $2.00 CO. IMP, NO.- JOB
M
HOUSE ScWER CONNECTING Iu
PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT NO. ROAD PERMIT NO,' L
CONNECT ADDITIONAL BLDG.OR
STATE ENCROACHMENT
--WORK TO H
- OOSE SEWER $1 DO PERMIT NO,
ALTER,
SEWER OR DISPOSAL SYSTEM INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE,
OWNER'S PERMIT 1 00
REIMBURSEMENT FEE
AUTHORIZATION ; TOTAL FEE -;e-/ --,,
APPROVALS DATE INSPECT<)
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- SIGNATURE
T To CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TRAC�OR L F
TO THE PUBLIC.�fiwE NEW HOUSE SEWER
SIGNED THIS DAY OF'
F a
19 CONNECT ADDITIONAL
OWNER OR '"'" BUILDING OR WORK
J�
OWNERS AGENT
SEPTIC TANK,SEEP,PIT(S)
ADDRESS 24�,,... AND/OR DRAINFIELD
I HE_R_E_.9_YA_CK_NO;LETG_F_1 4T I HAVE READ THIS APPLICATION CESSPOOLLI DDRYWELLO
ANDSTATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS.
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED As REQUIRED BY LOS ANGELES COUNTY AND ST5jH OF DISCONNECT PLUG AND
I ABANDON HOUSE SE ND
CALIFORNIA OR THAT I AM THE LEGAL P -1-HEi ABOVE
DESCRIBED RE31DENTIAk"OPER BACKFILL SEPTIC TANKS L!
SIGNATURE CESSPOOLS
J .m _41.tom
SEEP.P-41 IS)
OF PERMITTEE -1--4
OHN A. LANIBIE, COUNTY ENGINEER VALIDATION --- ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CASH/
4