HomeMy Public PortalAbout5749 OAK AVE_Sewer__ eD
96966IAPPLICATION FOR PERMIT 1
8 s 0D MSION OF BUIMING AND SAFETY SEWER SEWAGE D I S POSA L
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER + EBS
M CASSATT D GRIFFIN SUP T OR BUILDING
FOR APPLICANT TO M IN 3T
LEGAL
DESCRIPTION LOT NO O`er
BLOCKTRACT S"' MAI L
ADDRESS
NO OF SLOGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS � o� (jam DISTRICT I GROUP� I � M_AP
K
CONTRACTOR
ADDRESS S! �� CW( (A-�oj CONNECTION DATA
CITY TEL NO � — d' STATION !73. DEPTH
MANHOLE REFERENCE UPPER
❑ STATE L
REGISTRATION NO ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOY TYPE OFC ION LENGTH FROM
PUBLIC SEWER @ $S 50 �� P L N L TOP L
SEPTIC TANKSEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $9 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IYP NO JOB 00
EXTN CESSPOOL DRYWELL MANHOLE 0 $200
HOUSE SEWER CONNECTING TO O
PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER tit? $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PMDGT s f 00
AUTHORIZATION TOTAL FSE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE IN PECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK SEEP,PIT(S) ,
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS 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 AN 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 RESIDENTIAL PROtLR39 BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PERM ITT •
JOHN A LAMBIE COUNTY ENGINEERALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
r� p CK 9 O r 1 CASH
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