HomeMy Public PortalAbout5839 OAK AVE_Sewer__ s
aaEGGallae APPLICATION FOR PERMIT
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DMSION OF BURDMG AND SAFETY SEWER SEWAGE D1SP0AL
Depuatment of County Engineer
County of Los Angeles BUILDINGADDRESG
JOHN A LAMBIE COUNTY ENGINEER
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN 0 or C cc sT
LEGAL �, 3 OWNER
DESCRIPTION LOT NO
MAIL
BLOCK TRACT ADDRESS
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT — 21
USE DDISTRICT NO GROUP MAP PIS
CONTRACTO
BUILDINGS I J
R 47 _'r � K ` 7 a
ADDRESS A&DE
CONNECTION DATA
DEPTH
CITY TEL NO STATION LJ
MANHOLE REFERENCE
�p+I STATE LOWER
REGISTRATION NO O M COUNTY
No DESCRIPTION OF WORK FEE `
HOUSE SEWER CONNECTING TO TYPE 0 CTION LENGTH FROM
PUBLIC SEWER (d Y CURB P L M L TOP L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
EXTN CESSPOOL DRYWELL MANHOLE ® $200 CO IMP NO froo, JOB NO
HOUSE SEWER CONNECTING TO @ !�T
PRIVATE DISPOSAL SYSTEM $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $100 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERM a a..00
AUTHORIZATION EE TOTAL FREIMBURSEMENT FEE S
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTO AAE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEW NEW HOUSE SEWER
SIGNED THISDAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT ieu I SEPTIC TANK SEEP,PITS)
ADDRESS--- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL El DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TOMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW GULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PR Y GISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED LOS AN LES NTY AND STATE F
CALIFORNIA OR THA AM THE GAL O NER HE A E ABANDON HOUSE SEWER
DESCRIBED RESIDENT ROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S)❑ CESSPOOLS 2-1
OF PERMIT
JOHN A LAMBIE C Y ENGINEER ATIO ROBERT A WOOD CHIEF PBG INSPECTOR
CK M 0 CASR
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