HomeMy Public PortalAbout6113 OAK AVE_Sewer__ 7bA
E-663 9P-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
JOHN A. LAMBiE, COUNTY ENGINEER ADDRESS— — -
CASSATT D.. GRIFFIN, SUPT Or BUILDING LOCALITYT-
FOR APPLICAN NEAREST
T FILA NROSS ST.
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LEGAL y S —
DESCRIPTfON
MAIL J
BLOCK .-g A - �tJ- "I".r"-.'E s- ADDRE5.-S_-_-`s�-1 2 �--
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SIZE OF_LOT -- 6' 6'3;--NOW ON LUT - � CITY .-: fi E_ TEL. NO.
USE OF
BUILDINGS ' �'- '�d .�'°'' �:.:-.'.' DISTRI NO. 1 GROUP MAP
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CONTRACTORS--Via.._-.
CO
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- —- _ y --— NNECTION DATA —- —--
ADDRESS ✓.y`-� -• �. 6 .... --_—.-- ---- -- ---
STATION _: . DEPTH _
CITY 4 TEL. NO, MANHOLE REFERENCE
- - -- -
,.,�- STATE` .___ --.—r- - - -- LOWER
REGISTRATION NO. Jf> COUNTY ------"NO, j SCRIPTION 0( WORK FEE --- -'- ----- - ----- --- --
-"-- --- ------- --- -_--Dr-
TYPE 0 CONNECTIONEN H F 0
HOUSE SEWER CONNECTING TO ( 1
F LENGTH FROM
Y CURB P L. M.L.TO P.L.
.. _ PUBLIC SEWER L $3.50
SEPTIC TANK SEEPAGE PIT OR -
_ PIIS AND/OR DRAINFIELD _ Va $_3.001 -------- --- ---------- -----_
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN ,CEn POOL,.URYWELL,MANHOLE 6(i) 2.00 -- co. IMF. NO, JOB N0. -"
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM fz. $1.00 I TRUNK PERMIT N0, ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG OR ) - STATE ENCROACHMENT
_WORK TO HOUSE SEWER ( $1.00 PERMITNO
_] ALTER,REPAIR OR ABANDON HOUSE "-_.- ___-- ---"--�---- -!-
S VIER OR DISPOSAL SYSTEM L I.S 100 INDUSTRIAL._. . . WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT1 OD - --- - -- ----
__._�- -.---------�-- '--_ REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE ; Tf �T i�
APPROVALS DATE INSPECTORS SIGNATURE
-[ HAVE A7 THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- - _-.
TRACTOR TO CONNECT THE ABOVE DESCRISFD EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS -"-,.._�=41)AY OF— ,._-f.•.y_ 99.x- CONNECT ADDITIONAL -_--
OWNER OR _ - i' BUILDING OR WORK
OWNERS AGENT -
--
SEPTICTANK SEEP. PIT(S) f
.ADDRESS %�'-9 s/ - �.e ..�., AND/OR DRAINF ELD 1 -
1 HEREBY ACi(NOWLEDGE. THAT 1 HAVE READ THIS APPLICATION
CESSPOOL D DRYNELL[D
AND SATE THAT E ABOVE IS CORRECT ANDAGREE TO COMPLY
W:"TH ALL COWNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR �
PLUMBING AND SE`WERS. SEWAGE DISPOSAL SYSTEM
I HERECY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR DISCOJNECT PL- '-UG AND
---. ----- I--_-----
- --'-----
LICENSED F.5 REQUIRED BY LDS ANGELES COUNTY AND S'T'ATE OF i
ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM 'THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RES.IDEN�IA. PROPERTY. y �; BACKFILL SEPTIC TANKS l�
SIGNATURE �,+ SEEP.PIT(S) !-� CESSPOOLS
OF PERMITTEE
I
JOHN A. L,AMBIE.COUNTY ENGINEER' VALIDATION ROBERT A, WOOD, CHIEF PL.3G. INSPECTOR
CASH
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