HomeMy Public PortalAbout5832 OAK AVE_Sewer__ :6804565 APPLICA' =FOR PERMI�Jj`,p�.. �
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COUNTY OF LOS ANGELES SEWER SEWAGE DI POSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O LL
JOHN A LAMB* County M nglneer ADDRESS
COLLNI%'i R JF i kl,%S Sup t of Building
LOCAL TY 1"'m_g,
NEAREST
FOR APPLICANT TO FII. IN `Ross ST
LEGAL
DESCRIPTION LOT NO / OWNER
MAIL
BLOCK TRACT �1 ADDRESS10
1 S�j
512E OF LOT O 0 �7 U NOWOON L TS CITYLO& EL NO
USE OF DISTRICT NO GROUPJ_
PG MAP PROCESSED BY
BUILDINGS _
CONTRACTOR � BK
S �5. S SK
i/
ADDRESS (J - S CONNECTION DATA
CITY TEL NO �.� STATIONS DEP H
LICENSE LICENSE e--C.71/
p / UPP
NO O CLASS ` MANHOLE REFERENCE
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB PL ML TOP L
PUBLIC SEWER C $ 5 00 / >.
EPT ND/OC t PAGE PIT R CO IMP NO 3 [ JO i,� l
PITS AND/OR DRAINFIELD C $10 00 O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO U
PRIVATE DISPOSAL SYSTEM C $ 3 00 ad
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I wAIVEE EAEENENT RECORD INSTR NO DATE O
WORK TO HOUSE SEWER C $ 3 00
HODS
SEWER OR DISPOS C $ 3 00 V _
HWY OR ST WIDENING
EXTN CESSPOOL MANHOLE C $ 5 00 N
STATE ENCROACHMENT Z
PERCOLATION TEST C $ 5 OG PERMIT NO
J INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S P M a i o0
AUTHORIZATION TOTAL FEE
V"I� CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TOATHERPUBLIIC S. T ABOVE DESCRIBED EXISTING DWELLING APPROVALS
_ DATE- . DATE INSPECTOR 8 SIGNATURE
,L�]J1 l
SIGNED THIS DAY OF am`/ r 19&7
OWNER OR —v NEW HOUSE SEWER
OWNERS AGENT .L 4 l
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
1 HEREBY ACKNOWLEDGE TH 1 HUE READ THIS APPLICATION SEPTIC TANK SEEP PITS)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESCRIBED ID NTIAL PROPERTY ABANDON HOUSE SEWER
SIGNATUREjTJJ J BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑
VALIDATION
M O CASH
LAS,0 2 1 3* AUG 2 2 i j D 500
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