HomeMy Public PortalAbout5826 MYDA AVE_Sewer__ .6 A 64A64 2 U`fl-53 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION EuILOING �_
Engineer .
JOHN A. LAMBIE, County AODREss _ �— —__---
-- _
WILLIAM A. JENSEN, Supt of Building a
LOCALITY -.
NFARtST
FOR APPLICANTTO FILL IN CROSS sr— — — - ---
-
DESCPIPTION LOT NO. - OWER
MAI L
BLOCK TRACT � .�`j ADDRESS ---^±
NO. OF SLOGS
sizr LOT NOW ON LOT CITY TEL. NO.
Ilse of _ a't, �
BUILDINGS CROUP MAP RROCES`;E BY
I BK PG
CONTRACTOR
ADDRF55 4, CONNECTION DATA
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CITY N TEL STATION t. d� DEPTH /
F TATE.__ tTP'PER
fI ee nn °p MANHOLE REFERENCE
REGISTRATION O. !' y _ +y COUNTY
NO GESCPIFITION OF WORK - FEE -r-- TY}E OF t'QNNE._TION - LENGTH rft0•ryf -_
HOUSE.SEWER CONNECTING TO � i .. � t Y. CURfD L. M.:L TO P.L
PUBLIC SEWER -�.= '--- _ -- - ---
SER 1 ANK SEEPAGE PIT OR
n P...NO f9
T
$10.00 JOB NO_-___,._. .�
TS A-NO AOR ORAINFIFLD @ _ _ CO.IMP NO f - ------.-
H.0USE SEWER CONNECTING TO � � TRUNK PERMIT NO. ROAD PERMIT NO�. W.
PRIVATE DISPOSAL SY5TFM @ 33.00 ! _-
CO/VNECT AObI7iONAL BLDG.OR ! AEIDAuiT I WASY£R £AS£kENT RECORD.1NSTR. NO. DATE
WnRK TO HOUSE..SEWER $3.00
OVERFLOW SEEPAG_PIT,DRAINFiELD 1..-_ ! Uj
EXTN.,CESSPOOL.,ORYWELI..,MAP,4HOLE a $5.00
___._....-:., .�. -. - _____ .__- HWY.OR ST.WIDENING
ALTER-,R_EPAIR OR ABANDON HOUSE
EWER Or,RIEA OSAL SYS TE AS @ $3.00 STATE ENCROACHMENT
j PERMIT NO.
-----._..- INDUSTRIAL
_WASTE APPROVAL
CHARGES
OWNERS PERMIT z! oo -- ---- --- _-- --- --- __--
CONNECTION CHARGE FEE
AU III®RIZATION TOTAL FEE ? s
-I HAVE AT THES DATE A CONTRACT WITH THE HERE(N. NAMED COIL- REIMS' RSEMENT FEE
TRACTOR "TO .CONNECT TFIE ABOVE DESCNIISED EXISTING DWELLING --- --------- --- CT -GN
70 Y!+F. YUeL3e SLIN ER. p�- N APPROVAL r DATE I tNSP�.CTOR S SIGN
SIGNED THIS "��:�DAY OF
OWNER O4 NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL -------
BUILDiNG OR WORK I 1
ADDRE F-
5EP'TIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEELDGE THAT HAVE READ. THIS APPLICATION
RI
AND STATE THAT 11HE ABOVE 15 CORRECT AND AGREE TO COMPLY AND/OR---- FI.-LD
WF'(HALL COUNTY ORDINANCES AND STATE LAWS" REGULATING ..
PLU Ni RING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ -
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR -j._.__ --_-_ _-_�- -_-.,---
LICENSED AS REQUIRED BY LOS ANGLES COUNTY .SND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM, THE LEGAL OgWNER OF, AND INTEND TO --'
RESI:)E IN, THE AS V DESCRIBED RE�9 DENTiAL PROPERTY. C_ -T PLUG AND
�q ABANDON HOUSE SEWER
SIGNATURE f
BA.CKF!LLSEP7IC TAN KS -
OF PERMITT'FE ,4_ _ _-_ `..`-. - �.EF.,�.P.T(S) ❑ CESSPOOLS ` .
VALIDATION ROBERT A. WOOD
CK. M.e. cases SUPERVISING NIECH.ANICAL, ENGINEER
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