HomeMy Public PortalAbout5726 NOEL DR_Sewer__ 4.%%— 2"50 INSM.,
C88APPLICATION FOR PERMIT
78AG420 84:D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARYMEN'P OF COUNTY ENGIN=
BUDDING AND SAFETY DIVISION
FBU'LDING s^
DRESSOHN -LAISBIBA I>aN3ffii�uP t n=ng CALITY
AREST
FOR APPLICANT/ qTO FELL Di OSS ST
DESCRIPLEGATION LOT NO 1.3 S^ J -A�' OWNER
BLOCK TRACT NAIL
ADDRESS
OF
SIZE OF LOT t 3 S )4. NOW ON LOTS CITY TEL NO
USE OF DISTRICT NO GROUP HE MAP PRO ED BY
BUILDINGS
CONTRACTOR f O ,�.
r
Zso--LI
ADDRESS GTION DATA
CITY L NO I- / STATION / r DEPTH
STATE MANHOLE REFERENCE PPE
REGISTRATION NO 2 / <2)-,;r B COUNTY Q t
No I DESCRIPTION 0 WORK FEE
HOUSE SEWER CONNECTING TOPUBLI $300 V V
TYPE OF CONNECTION LENGTH FROM
SEPTIC T�NK SEEPAGE PIT OR Y CURB P L M L TO P L
PITS AND OR DRAINFIELD 0 $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTNCESSPOOL
DRYWELL @ $200
HOUSE SEWER CONNECTING TO J C NO 0
PRIVATE DISPOSAL SYSTEM SI 00 CO IMP NO OB NO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER $100 TRUNK PERMIT NO ROAD PERMIT NO
ALTER OR DI IR OR ABANDONPOSAL STSTEM HOUSE Lo $100E ENCROACHMENT 0PERMIT NO O
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT 51 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEEIN NAMED CN
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIRSTING DWELLING APPROVALS DATE INSPECTOR S SI6 ATURE
TO THE PUBLIC SEWER
SIGNED THIS O '�t� 19-6-Z NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDI S AND/OR DRAINFIELD
1 HEREBY ACKNOWLED6 HAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE AB VE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESNTI PROPER BACKFILL SEPT C TANKS ❑
SIGNATURE SEEP PITS CESSPOOLS 13
OF PERMITTE
®� VALIDATION ROBERT A WOOD
CI, M ° SUPERVISING MECHANIC"ENGINEER
LAS04 MR 28 D 5C30 tj