HomeMy Public PortalAbout6143 OAK AVE_Sewer__ 2465604SiR75 a
6AE;4 D
7APPLICATION FOR PERMIT
6A642COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING . .
BUILDING AND SAFETY DIVISION ADDRE54; _ ''.�" z�
JOHN A.LAMBIE, County Engqineer
WILLIAM A IENSEN, S.p'I aI Bonding LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL.
DESCRIPTION LOT NO. .% OWNER
BLOCK TRACT : f _ MAIL _y
"";w ADDRESS
NO.OF BLDGS, a"
SIZE OF LOTNOW ON+LOT '° CITY TEL. NO,
USE OF
BUILDINGS f -'.r'_- t DISTRICT NO. GROUP MAP PROCE�SEDBY
BK PG r
Collvl TOR -
ADDRESS - Jz z CONNECTION DATA
CITX ` TEL.N0. ;' y y b STATION DEPTH
�_, y STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. ,f 1' ,''5;z' / COUNTY LOWER
No. DESCRIPTION OF WORK ftE
HOUSE SEWER CONNECTING TO r�._?,� •' _ f, � -v � i PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR. Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3,00 -
OVERFLOW SEEPAGE PIT, DRA.INFIELD J
Ekrl_...C SSPOOL...DRYWELL @ 32.00 -
MOUSE SEWER CONNECTING TOP.C, 0.
PRIVATE DISPOSAL SYSTEM @ $1-00 CO,a�IM NO. JOB 0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 I / TRUNK PERMIT N0. ROAD PERMIT N0. Q
it
u
ALTER" .REPAIR OR Al-AND9N HOUSE STATE ENCROACHMENT
134
S£W R OR GISPOSAL SYSTEM Ca) $
1.00 PERMIT NO,
INDUSTRIAL
� i WASTE APPROVAL
Pa
_ CHARGES to
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORMTION I TOTAL FEE ""' REIMBURSEMENT FEE
I HAVE AT CON-
TRACTOR I 1 0 THIS
THEO NTRACT ABOVE DESCRIBED EX STNNGWITH THE HEREIAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE.
TO THE PUBLIC SEWER.
SIGNED THIS DA„Y QF15— NEW HOUSE SEWER
OWNER OR !CONNECT ADDITIONAL
OWNERS AGENT .G s BUILDING OR WORK
ADDRESS— 9 SEPTIC TANK,SEEP.PIT(S)
AND/OR GRAINFIELD
LARESY ACKNOWLEDGE THAT E HAVE READ THIS APPLICATION
ATE THAT THE Py4OVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYW.ELL ❑
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
ING AND SEWlSfS. SEWAGE DISPOSAL SYSTEM
REBY CERT Y THAT 1 AM P13OPERLY REGISTERED AND/OR DISCONNECT PLUG AND
ED AS RFRED BY LOS ANGVLES COUNTY AND STATE OFABANDON HOUSE SEWERRNIA ORS LHAT t AM THE LE AL OWNER OF THE ABOVEBED RENTIAL PROPERTY. BACKFILL SEPTIC TANKSr SEEP.PIT(S) ❑ CESSPOOLS ❑URE - 1 r�RM( T
VALIDRTIC ROBERT A. SNOOD
CK. X.0. �.._casJl% SUPERVISING MECHANICAL ENGINEER