HomeMy Public PortalAbout5940 OAK AVE_Sewer__ 24650 INSERTS r
QEAPPLICATION FOR PERMIT
70A6490 B4YD COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGIIdEM BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 5940 N. Oak
OHN A LttIMBIB Cevntp es
A IENSI:N Supt of Sw)dmQ LOCALITY Temple C3-t
LEGAL FOR APPLICANT TO M IN
c"nose SY T ns
DESCR PTION LOT NO �] L OWNER Sau Gabriel Lumber Coo
BLOCK TRACTMAIL
6-61ADDRESS los Tunas Dr.
SIZE OF LOT NOW ON LOTS �e CITY Te)�ple C1tY TEL NO
USE OF :D�ISTIRICT NO GROUP BK MAP PR ED BY
BUILDINGS
CONTRACTOR Andrews Plul�bin _
ADDRESS W Colorado CO CTION DATA
CITY Los Jin el 8 TEL NO CI.. —88 6 STATION DEPTH
p STATE MANHOLE REFERENCE
REGISTRATION NO ZS 2 COUNTY LOWER
No I DESCRIPTION OF WORK FEE
PBECONNECTING TO
x ULICSEWR0 $300 9 00
TYPE OF CTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L
PITS AND/OR DRAINFIELD a SS 00
OVERFLOW INFIELD
S2 00EXTN CESSEOOLERWEDL
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO O O
WORK TO HOUSE SEWER 1 00 V
ALTER REPAIR R L SYSTEM HOUSE S1 00 STATE ENCROACHMENT N
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PF-RBUT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 00 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER �e�
SIGNED THIS 12th DAY OF TanuA= 1962 NEW HOUSE SEWER
OWNER ORGabr 61 e C * CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
ADDRES •naaz&ab Wuu AND IC TANK SEEF
IELD PIT(S)
AHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL 13
LDESCWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
RI
MBING AND SEWERS SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND i
ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
IFORNIA OR TAT 1 AM THE LEGAL OWNER OF THE ABOVE
BEDRESIDTIAL PROPERTY BACKFILL SEPTIC TANKS ❑NATURESEEPITS CSPOOLS PERMITT
®F �ATION ROBERT A WOOD
�E. M ° CAIN SUPERVISING MECHANICAL,ENGINEER
U; 7 0 h 7% JUJ 15 3 0 u 5 0 0 n
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