HomeMy Public PortalAbout5947 OAK AVE_Sewer__ 1 � �
'°A°°'° APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
MARTbUM OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION BUILDING
ADDRESS
OFIIf A LAIrlBEE County e°s
iT D GRIFFIN Supt of 8t d%g LOCALITY
NEAREST
FOR APPLICANT TO FITd. IN ICROSQ BY
LEGAL OWNER
DESCRIPTION LOT NO
BLOCK TRACTNAIL
ADDRESS.- �i
,�-7� NO F BLDGS
SIZE OF LO7V NOW ON LOT CITY EL NO
USE DDISTRICT P NAP V:7
BY
BUILDINGS BK P6
CONTRACTOR /
ADDRES�F" CONNECTION DATA
CI EL NO / STATION V f 3� DEPTH
UPPER
COUNTY MANHOLE REFERENCE
REGISTRATION NO L ER
No I DESCRIPTION OF WORK FEE
PUBLIC SEWECONNECTING TO 0 $3 00
SEPTIC TgNK SEEPAGE PIT OR Y TYPE OF CURB
CONNECTIONP L. N L TO P LNGTH OE
PITS AND/OR DRAINFIELD $S 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL 0 S200
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 51 00 CO INP NO J� JOB NO
CONNECT OR
WTADDITIONAL BLDG
S1 o0 TRUNK PERMIT NO ROAD PERMIT NO s'rs�
SEWER RE DISPOSAL SYNDON HOUSE SI 00 STATE ENCROACHMENT �A '
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERBUT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE n/p ®L p r S rP'
CON
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGDAA CONTRACT WITH THE HEREINAMED DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS_ AY 0E 9 NEW HOUSE SEWER 2 .G�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-- �� BUILDING OR WORK
ADDRESS.TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COU ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I THE LEGAL R THE ABOVE
DESCRIBED RESIDENTI R ERTY FI
ACKLL SEPTTANKS ❑
SIGNATURE SEEP PIT S IC
CESSPOOLS
OF PERMITTE 6
®� VALIDATION ROBERT A WOOD
M O cesM SUPERVISING MECHANICAL ENGINEER