HomeMy Public PortalAbout6047 OAK AVE_Sewer__ 246501NSkR s
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78A642D 60 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS NG
rgiaaneer
.ADDRESS
WILLMM A.A. JENSEN, Sup't ofuBuilding
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN
DEscnG�rioN Lor No. r. � �.5 C= OWNER c =
BLOCK TRACT µ. MAIL f,
ADDRESS . .-�e'" °�.'(`—m•'.
N0.OF B1fDGS,
SITE OF LOT NOW ON LOT CITY TEL. NO
USE OF !
BUILDINGS - �- �.����-�
DISTRICT NO. GROUPMAP F9CESSED BY
--- BK PG
CONTR OR ✓ .: p.
A
DDRESS ' , -" + CONI�TECTION DATA
TY < , -� - TEL.NR 5TAT10N "` le DEPTH
STATE MANHOLE REFERENCE -"� '`- UPPER
GISTRATION NO. COUNTY
J IIE,CRIPTION OF oORK FEE-.
HOUSE SEWER CONNECTING TO � R r"
PUBLIC SEWER __@ $3.00 , TYPE OF CT10N LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y. � P.L. M.L.TO P.L. �-
PITSANDiOR DRAINFIELD _@_
I OVERFLOW SEEPAGE PIT. DRAINFIELD
,s( EXT L.CESSPOOL. DRYWEI.L S2.00
HOUSESEWER CONNECTING TO _ P.C.NO. ..
PRIVATE DISPOSAL SYSTEM @ $1.00 _CO. IMP. NO, - JOB NO.
CONVECT ADDITIONAL.BLDG,OR
TRUNK PERMIT N0. .ROAD PERMIT NO. ;' 0
WORK TO HOUSE SEWER C? 5].00 c U
AI:iER, REPAIR OR.ABANDON HOUSE STATE ENCROACHMENT Ci
SEWER OR Dd"OSAL SYSTEM C .$1.00 PERMIT NO, O
INDUSTRIAL U
WASTE APPROVAL W
CHARGES N
OVMER'S PERMIT 5 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE,=H IN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXI SING DWELL 9G APPROVALS DATE IN5PECTOR'S SIGNATURE
';"0 THE PUBLIC SEWER. '^.
SIGNED THIS 75tc0 P V� 1 NEW HOUSE SEWER I6
OWNER ORS._.,, > CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
-- --
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL I] DRYWELL [�
WITH AL1. COUNTY ORD NANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS,,.' - � SEWAGE DISPOSAL SYSTEM
LICENSED AS REQU[ E
I HEREBY CERTIFY,THAT i AM PROPER Y REGISTYT ND REATE DF D 'ND/OR
— -
e.D BY LOS ANGEL£ COUNDISCONNECT PLUG AND
STABANDON HOUSE SEWER
CALIFORNIA OR T I AM THE LEG WN R �f¢THE ABOVE
DESCRiEED RES E �(,� F.OPERTY. BACKFILL SEPTIC 7ANKS
r .r°,_..��t ``� - SEEP..PIT(S) ❑ CESSPOOLS
SIGNATURE - ----_--.—
OF PERMITT —
�� VALIDATION,-, `. ROBERT A. WOOD
CK. X.0. JCASH d SUPERVISING MECHANICAL. ENGINEER