HomeMy Public PortalAbout6105 OAK AVE_Sewer__ E
i&E--66663 11.55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
.101-#N A. LAM$IE; COUNTY ENGINEER —ADDRESS
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY FB
FOR APPLICANT TO FILL IN CROSSs,c, — - , 1�" OWNERTION LOT NO .yMAIL✓�. TRACT ". - ., ADDRESS -!o � a` �� a&�'
/' ser y L0�__ NOW ON L T ., CI7Y �� .-_.DISTRICT NO. GROUP MAP
GSBK PG
CTOR #SCONNECTION DATA- 41
^� TEL.HO p { x _57ATION i'- � „�—_--_DEPTH _-.,—�-. _— " MANHOLE REFERENCE =Et
r' ,,r 4. �.5 0 STATE --"._._...—.�. LOWER
REGIST'RA'TION N0. — � ' _ �F — COUNTY - --
N O, j DESCRIPTION OF WORK FEE ---=— -------- -------- ------
--- - —_—._ TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING 70 Y, CURB P.L.
--------- M.L.TO P.L.
PUBLIC SEWER-- - --- - ---- -'$3_50 ---- —.----_
---r
SEPTIC TANK,SEEPAGE PIT ORPITSAND!OR DRA_INFIELD _ _ `� $3.OD! — ---- —_ _
—; OVERFLOW SEEPAGE PIT,DRAINFIELD ---�--C�---^ �' P. C. NO. - ----
i
EXTN.,CESSPOOL.DRf4 LL,NIANP.OLE C_$2.001 CO. IMP- N0. � .JOB NO.
j HOUSE.SEWER CONNECTING.TO --T----
- a PRIVATE DISPOSAL SYS EM rz $1.00 TRUNK.PERMIT N0. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK 10 HOUSE.SEWER r $9.00 �— PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
I INDUSTRIAL
SEWER 0R DISPOSAL SYSTEM 0 $1.CG f
-_--- _-- - —_ -- ---- 'HASTE APPROVAL .
CHARGES
_ --- I
CONNECTION CHARGE FEE - -
OWNER'S PER1`ltlT --- - ---�----
-- s 1 00" REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A. CONTRACT WITH THE. HEREINItiAME6 CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING. DWELLING
TO THE PUBLIC SEAE,R+° 1 NEW HOUSE SEWER
SIGNED 7HIS__tfi i['_—DA4 — --- -- —
OOPdNEC7 ADDITlOkAL
OWNER ORBUILDING OR 'WORK
OWNERS AGENT - ./ n;?} ��-t_..,.. —_- _
— SEPTIC TANK,SEEP,PIT(S)
ADDRESn _ AND/OR DRAINFIELD -
I HEREBY fir NOV,LEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL(, DRYWELL❑
AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REG-ULATING ALTER.REPAIR SEWER OR
PLUMBING AND SEWERS. SEWAGF DISPOSAL SYSTEM _
HEREBY CERTIFY THAT I AM_ PROPERLY REGISTERED AND/OR G AND
D
LICENSE& AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT PLLHOUSE SEW
.CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE -----I---- -- --
ER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(._ -
SIGNATURE SEEP-PIT(S) L CESSPOOLS❑ j
OF PERMITTEE _ -
JOHN A. LAN1 1 t COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M. B. CASH - -