HomeMy Public PortalAbout5836-5838 OAK AVE_Sewer__ � .4
'E808 5
76AG42D6$ APPLICATION F / PERMIT
COUNTY OF LOS ANGELES
SEWER-SE AGE DISPOL
DEPARTMENT OF COUNTY ENGINEER E
BUILDING AND SAFETY DIVISION FU ...NG a 3 ���
JOHN A LA\IBIL County Engineer COLE\IAN W JFNkINS Sup t o[ Building TTYSTFOR APPLICANT TO FILL IN ST
LEGALDESCR PTION LOT NO //�� ""' ` OWNER
MAIL
BLOCK qkPH51 =� {
�{L! .a.0 ' �1
TRACT /� ADDRESS
SIZE OF LOT/0 U v-1 q 0 NOWOON LOTS CITY TEL NO .8
USE OFDISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS
BK PG
CONTRACTOR MIKE Plr, S/
ADDRESS q/57 a Ctj_6-j_4W �WWU _f" CONNECTIO DATA
CITY TEL NO —&6W STATION DEPTH
LICENSE ok LICENSE ���� UPPER
LI / CLASS MANHOLE REFERENCE tv
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB PL ML TOP L
PUBLIC SEWER C $ S 005EPT
C E PIT OR PC
PITS IAND/OR DRAINFGELD C $10 00 CO IMP NO JO //p�lS O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO (�
PRIVATE DISPOSAL SYSTEM C $ 3 00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I wAIVE■I EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER C $ 3 00
'ALTER RE PAIRR
HODS
SEWER OR DISPOSA C $ 3 00
HWY ORST WIDENING
EXTN CESSPOOL MANIC LE C $ 5 00 STATE ENCROACHMENT H
PERCOLATION TEST C $ 5 OG PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S 2 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THg ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC S�Wff��R DATE INSPECTOR S SIGNATURE
SIGNED THIS per_DAY OF 190
OWERORGNEW HOUSE SEWER
OWNENT
CONNECT ADDITIONAL
ADDRESS / BUILDING OR WORK
I HFREBY ACKNOWLEDGE THA H E READ THIS APPLICATION SEPTIC TANK SEEP PITS)
AND STATE THAT THE ABOVE IS OR CT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
LPLUMBIENGAND SEWERS CESSPOOL ❑ DRYWELL ❑
CERTIFY THAT IAM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWEROR
S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
THE ABOVDESCRI RESIDENTIAL PROPERTY ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKSTTEE
SEEP PIT(S) ❑ CESSPOOLS ❑
VALIDATION
CK M O CASH
Lt1t Ifl o fr 1 6- rwG 2 2 1. 0 D 5 GO-
r,z "
�