HomeMy Public PortalAbout6026 OAK AVE_Sewer__ r.808.8 APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE D I SPOSA L
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 'BUILDING
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JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building CALITY ,r AREST
FOR AP UCANT TO FI,LLL IN CROSS STLEGAL .
-DESCR_IPTION LOT NO. �I • L a )F d OWNER "
BLOCK. TRACT ', MAIL r r r'
ADDRESS to L�,,,, 41 i-? Pte'
r NO.OF BLDGS. ja �e
SITE OF LOT NOW 6N IAT d CITY C, TEL.N0.
USE OF
BUILDINGS _YDX, e:" a s DISTRIGT NO. GROUP MAP PROCESSED Z
..) BK PG
CONTRACTOR A/ `J
ADDRESS •. , , CONNECTION DATA
CITYAd
- i4D TEL.NO. STATION DEPTH
/so' f t Z ❑ STATE >
MANHOLE REFERENCE%
REGISTRATION NO. [� COUNTY LOWERf''/ a r{
NO, DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM -
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD —
EXTN.,CESSP001.,DRYWEI.L,MANHOLE 0 $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. i JOB NO,
CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER, REPAIR OR ABANDONHOUSE STATE ENCROACHMENT
PERMIT OR DISPOSAL SYSTEM $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2100 CONNECTION CHARGE FEE
AUTHORIZATION FT70TAL FEE I'L' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVAL a DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS A OF `q S -NEW HOUSE SEWER v __
OWNER OR `Y-^°- _ ?r CONNECT ADDITIONAL
OWNERS AGENT '` :"' BUILDING OR WORK
? SEPTIC TANK, SEEP,PIT(S)
ADDRESS �.;' '' _+�` �` -"-'z _AICD/QR DRAINFIELD
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND 5EWERS, SEWAGE DISPOSAL SYSTEM
I HEP,LNY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ISCONABANDON CT PLHOUSUG
SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER 10F THE ABOVE
DESCRIBED RESIDENTIAL PVPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE �Z�
SEEP.PIT(S) CI CESSPOOLS
OF PERM ITTEE_ '
VALIDATION ROBERT A.WOOD
6K.: K.Qa CAWH ' SUPERVISING MECHANICAL,ENGINEER