HomeMy Public PortalAbout6116 OAK AVE_Sewer__ APPLICATION FOR PERMIT
i&E•E33 I1-S5
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING f ] f r
JOHN A, LAMB6E, COUNTY ENGINEERADDRESS
CASSATT D. GRIFFIN, SuP'T OF BUILDING - LOCALITY
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FOR APPLICANT TO FILL IN CROSS'S Sr_
LEGAL—--- ----- �OWNER —
DESCRIPTION _LOT NO a -F- �*I" MAIL
BLOCK TRACT ,v�� - ADDRESS/'
NO. OF BLDG$.
512E ,f_0F LOT d t,!Cl _ NOW ON LOT CITY - : : („�„ TEL. NO.<._Y
USE
LDFNGS_ ./�� .'-3'-yL"y--Jj f°I, `��----- -- DISTRICT NQ, 1 ''GROUP MAP
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CONTRACTOR ` t - ! -- -- ...�
— CONNECTION DATA — --
ADDRESSi. -
>-- - STATION DEPTH
-
CITY
TEL NO ^- �a Ll" " .'ter
MANHOLE REFNCE s UPPER
✓ a --- .� STATE -,"e• -- ---'--- - LOWER
REGISTRATION NO, j 4 COUNTY . is
DESCRIPTION OF WORK FEE _ ---- -- ----- '-- -- ---
NO TYPE OF CONNEC7i0N ENGTH FROM
HOUSE SEWER CONNECTING TO y CURB P L '' TOP L
-�. PUBLIC SEWER (a� $3,50 -
i SEPTIC TANK.SEEPAGE PIT OR v'-------_---
---�. PITS AND"OR DRAINFIELD rr $3,00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO,
E TN.,CESSPOOL,DRYWELL,B1NI?OLE lug $2.00.I CO, IMP. NO. ' JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEPA (;3t $1.00 ; RUNK PERMIT NO ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG,OR I STATE ENCROACX`MENT
WORK TO HOUSE SEWER Oil $1.UO PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE 1NDUSTRlAA --- --- --_--- --- -- -_--¢-
_ S£WIq OR DI POSt L SYSTEM { $.1..OU L I tJASTE APP OVAL -
`f-0 __—
'` ._I CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00— REIMBURSEMENT FEF.
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE IINSPECTOR'SSICNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, NEW HOUSE SEWER
SG
INED THIS —DAY OF CONNECT ADDITIONAL -- ----
OWNER OR BUILDING OR WORK
OWNERS AGENT -- --- SEPTIC TANK,SEEP,PIT(S)
_ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE. READ THIS APPLICATION CESSPOOLO DRYWELL❑ I.
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM (
t HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND i - i -------
LICENSED
_-_
LICENSED AS REQUIRED BY .I.OS ANGELES COUNTY AND S'I_ATE OF ABANDON CT PLUG AND _
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE ABAN --USE- - - ----.
DESCRIBED RESID-NTIAL'PROPERTY, ; BACKFILL SEPTIC TANKS
(
SIGNATURE SEEP.PT(S) L CESSPOOLS J
_ .. .._ ---...--.--
OF PERMiTTEF�. " �_
i
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CASH