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HomeMy Public PortalAbout6132 OAK AVE_Sewer__ 16A642D-CE•8.08-10-71 APPLI TION F,®® ®E MIT COUNTY OF LOS ANGELES 9 911 Q4; 1�$ WE —.SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUIL ess Y g:f . _ LOCALITY NEAREST FOR 'APPLICA 0 FILL IN CROSS ST. LEGAL. •' �� DESCRIPTION LOT NO. OWNER MAIL: BLOCK TRACT "'�/ ADDRESS `� y NO: OF SLOGS'. _ .SIZE OF LOT NOW ON LOT _CITY _TEL. NO. _ USE OF fiMAHOL BUILDINGS C .. OUP M'AR. PRO 'S9ED BY'�" BK PO CONTRACTORADDRESS "� ' 11 ✓ CONNECTION DATACITYTEL. NO: D.EPTWfLIENSE NO, -/ GLASSTATE ENCE'd "n 61 a,o LOWER NO. .DESCRI N OF WORK FEE. JJON _+'',r LENGTH FROMHOUSE SEWER CONNECTING TO URB :P'.L. M.L.TO P. PUBLIC - PUBLIC SEWER 19 $7;00 NO. SEPTIC QIOR SEEPAGE PIT OR T PITS ANDRA�INFIELD �. $'.I'0.00 CO.,IMP.:NO. !� JOB'NO: HOUSE SEWER CONNECTING TO• } PRIVATE.DISPOSAL SYSTEM @ S3.00 T.ijUNK PERMIT NO. ROAD PERMIT NO. 7-2- d CONNECT-ADDITIONAL BLD OR. AFF.1'DAV I.T' wAlv[R [A$[M[xT RECORD.INSTR.NO. DATE O VOQAIMi HOUSE SEWER .. $3.00 ` , OVERFLOW SEEPAGE PIT.DRAINFIE L D .. i _ .. O EXTN..CESSPOOL.CRYWELL. a $B.00 ALTER,REPAIR OR ABANDON'HOUSE - HWY.0R'ST,WIDENINGC'R.� SEWER OR DISPOSAL SYSTEM :®: $3.00 STATE ENCROACHMENT MANHOLE '$7.00 PERMIT NO. - - - INDUSTRIAL N pp�� .WASTE APPROVAL Z_ O tlr������i`EES PERMIT $ .0 - CHARGES CONNECTION CHARGE FEE 7ATT-HORMATION I TOTAL FEE I HAVE.AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. 'REIMBURSEMENT FEE - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUB Cr SEWER.: APPROVALS DATE 1NSPECTOR'.S SIGNATURE SIGNED FIS DAY O� 19_ ,�- OWNS R F� _ g f NEW HOUSE SEWER6/ OWN AGENT iS,YY�"""�'�� + 1 CONNECT ADDITIONAL ADDRESS BUILDING G OR WORK �'�� ,'1 '��f_ Y-•_ I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SAND/C TANK'.SEEP.PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND.AGREE TO COMPLY AND/OR DRAINFTELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY 'THAT 1 AM PROPERLY REGIST RED A'ND/OR ALTER.REPAIR.SEWER OR LICENSED 'AS REQUIRED BY .LOS ANGLES COUNTY D STATE OF SEWAGE'DISPOSAL SYSTEM CALIFORNIA OR THAT I AM'THE LEGAL OWNER OF. D INTENDTO DISCONNECT PLUG AND RESIDE IN. TN ABOVDESCRIB�S;OE�L ROPERTY.• ABANDON HOUSE SEWER SIGNATURE OF PERM AC1(FILL SEPTIC TANKS ❑ • .SEEP.PIT(S) E3. CN ❑ VALMA77ON cx. W.O. cases '1 5 9 ghAy 7 10 U 1. 9.5 0