HomeMy Public PortalAbout6032 OAK AVE_Sewer__ 7
E608.8s APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F
G
IOIiN A. LAMBIE, CountyS
Engineer
CASSATT D. GRIFFIN, Supt of Building YTFOR APPLICANTTO FILL IN T.
LEGAL
DESCRIPTION LOT N0. - _OWNER f;
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SI7E OF LOT NOW ON LOT CITY TEL 'NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR I ry I ff
ADDRESS /CO ECTION DATA
CITY L.NO. -r' STATION _ +€ kl DEPTH '
��jI STATE MANHOLE REFERENCE
REGISTRATION N0, l.l--�OUmTY °
NO. DESCRIPTIOk OF WORD; FEE �� �r �=r�~' d LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF Cl y TION LENGTH FROM
SEPTIC TANK,.SEEPAGE PIT OR .
PITS AND/OR DRAINFIELD Q $3.06 Y. JCURB; P.L. M.L.TO P,L. �! h
OVERFLOW SEEPAGE PIT,DRAINFIELD A
E%TN..CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEMQ $1.00 CO.IMP.NO. ?� JOB NO,
CONNECT ADDITIONAL . ROAD PERMIT NO.
BLDG.OR TRUNK PERMIT H0
WORK TO HOUSE SEWER_ e@ $9.00 ^
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM Lro $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL.
CHARGES
OWNER'S PERMIT Z 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APFROVALS DATE INSPECTOR'S SIGNATURE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER,
SIGNED THIS--"----DAY PF—___ 1.9 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL _� �
OWNERS AGENT BUILDING OR WORK I
SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE ES CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL D
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL FROFERTY, BACKFILL SEPTIC TANKS C]
SIGNATURE
SEEP.PIT(S) I� CESSPOOLS❑
� ".� f '",� i
OF PERMITTEE
VALMATION ROBERT A.WOOD
LK., 1t.Q. CAtN SUPERVISING MECHANICAL ENGINEER
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9 i.