HomeMy Public PortalAbout6135 OAK AVE_Sewer__ APPLICATION
5&[-6613 t.>rg i
DIVISION OF BUILDING AND SAF'E'TY SEWER-SEWAGE DI SAL
Department of County, Engineer
County of Imes Angeles BUILDING r
ADDRESS
tJ �GASSATT U GRIFFIN, SUf�T OP tlUiLDING LOCAL'TY.
---- -=F APPLICANT TO III. IN - cos ST._ e ----- -
r t
'3ESCRiPTP:ON I,OT-NO. OWNER
MAIL
TRACT .L. " _ „I Co. MAIL
sC�.�1.5.4�, d'�.��..�Z� ,E��IEE�, � ADDRESS
SIZE OF LOT. - NOWQONBLOT'S. ... CITY T 't? le C. E. - TEL. N0.,ilT. 66787
-
USE Ol'
BUILD(PdCs. T ' ,m- -. .. DISTRICT NO. ! GROUP MAP
T-- -.._--.._ --- - ---
G
CONTRACTOR J �idO E Zl I.a! Co. O-F SO. _
-- --� --
CONNECTION DATA >�
AD Ross8 . ;n E % 'ro
_ cy STATION _�,: _ DEPTH .,'.; ..
CITY ....1.. :__ s - _TEL.:40�.� _ _. } cJ,r ,. -. Ivi.A:N.HOLE REFERcNCE� - - --6.PcA--
' STATE
REGISTR:ATION N0. 14`x12 11 COUNTY ---- i- ^�- - '--
NO. I DESCRIPTION OF WORK --_ FEE - ------ - -- –. ..__--. —
.– __-
Nr US.St N!ER CONNECTING TO —I - TYPE OF COt_iVECTION LENGTH FROM xy
PUb C SEL ER _ $3.59 I_ "CURB £r: M L 70 P L. -
SEPTIC TANK SEI-,PAGE PiT OR
NITS AND/OR DRA_INFIELD _ t`u ^ 3,,00
.
OVERFLOW EEP CE PI -
ORAtNF-1F_ ---- 1 -- -- P C. NO, --
_
T—HOUSE
ROLE @ $2.00 CO, IMP Pd O. JOB NO.
.SEWER CONNECTING TO P ---- ---- ._.� — -- ,— ---
PRIVATE DISPOSAL SYSTEM Ota $i.0� � � TRUNK PERMIT NO. ROAD PERMIT NO..
_f
CONNECTADDITIONAL BLDG OR -.-� ,_.--- .ENT --� STATE ENCROACHMENT �--
�J WORK TO HOUSE SEWER ee-S 1..0_0 _-_-_�-- PERMIT
I NO-
ALTER,REPAIR OR ABAN 'N HOUSE INDUSTRIAL
--- - ---------------
-_-i.
SEWER OR DISPOSAL SYSTEM _ ff `^i.00 WASTE APPROVAL
I CHARGES
-- -----..--.—.._.CO CONNECTION CHARGE EE
OWNER'S PERMIT - � .�--- ---'----- -------
>� t
` _.----------- ..-----41- -- REIMBURSEMENT FEE -
AUTHORIZATION TOTAL PEE
I APPROVALS5
DATE ASPE';,7 S.IGNAiURE
7 H THEHEREIN NAMED CON-
NAVE AT SATE A CONTRACT 19iT
TRACTOR TO CONNECT HE ABOVE DESCRIBED EXISTING DWELLING !
TO T 9 lPUBLi(" ICER:; NEW HOUSE SEINER
SIGNEID THIS. --_ DAA'OF 19 T: CONNECT ADDITIONAL - �1— -- — ---
OWNER OR'"- :" BUILDING D WORK
a -- --- �.-----------------
OWNERS AGENT n �
a SEPTIC TANK,SEEP,PIT(S)
ADDRESS'
7 e '� L •'0 - AND/OR DRAINd IELD
�"'--v — —------------ - --..-- —
I HEREBY ACKNOWLEDGE THAT I HAVE REAP Ti4l S "+PF1'.IC010 CCESSP00LLI GRYYWELLE].
AND STATE THAT ,HE ABOVE IS CORRECT AND AGREE TO COMPLY ... ___- _..-- - ---J..------L
WITH ALL. .COUNTY ORDINANCES AND STATE. LAWS REGULATING ALTER,REPAIR SEWER OR I I_
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM - I
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AN 1) o --� — _.`�—'---- --`--'—T —_—.._-_---_—�__--
L.I,,FN$ED AS REQUIRED BY LOS ANGELES COUN y ANll^,^-,TAT£ OF DISCONNECT PLUG AND
'A LIFOR QIA O TPAT A r THE LE GAL OWxi`E. 0`° `C;tif A&LSifE: ABANDON NOUS bc.LVER
C r RF E S PE}„' .Y- ,_, ;. `9 BACKFILL Sc I TANKS-1
— — —
Jai __..
u`-"W SEEP.PIT(S) u
CL.I C SPOOLS ,J '
OF-PERMfTTEE
IOHN A. LAIVIBIE, COUNTY ENGINEER VALIDATION RCEIEIRT 777050H),CHIEF PL.BG. INSFECTOR
WX, ��� <'